Considered differential diagnosis include atherosclerotic and syphilitic aneurysm and workup was only remarkable for a positive syphilis screening test with reactive VDRL & RPR that was confirmed with a positive TPHA, he tested negative for HIV. The patient was diagnosed with tertiary cardiovascular syphilis and a decision was made to treat the aneurysm surgically as soon as possible because its growth could potentially rupture and risk the patient’s life.

He was surgically managed with aneurysmorraphy and thrombus evacuation, the aneurysmal section was resected and replaced with Dacron graft. The first dose of 2.4 million/unit IM Penicillin-G was given to be continued for 3 doses. He had a smooth postoperative condition and was doing well on 6 months post operative follow-up