Thoracic aortic aneurysm
Key points
- A thoracic aortic aneurysm is a localized expansion of the wall of the aorta.
- Thoracic aortic aneurysms are caused by hardening of the arteries (Atherosclerosis), High blood pressure (hypertension), congenital disorders such as Marfan's syndrome, trauma, or less commonly, Syphilis.
- Most patients have no symptoms until the aneurysm begins to leak or expand.
- A Chest x-ray and chest CT scan demonstrate enlargement of the aorta.
Alternative names
Aortic aneurysm - thoracic; Syphilitic aneurysm; Aneurysm - thoracic aortic
Definition
A thoracic aortic aneurysm is a localized expansion of the wall of the aorta.
Causes, incidence, and risk factors
Thoracic aortic aneurysms are caused by hardening of the arteries (Atherosclerosis), High blood pressure (hypertension), congenital disorders such as Marfan's syndrome, trauma, or less commonly, Syphilis.
Atherosclerosis is by far the most common cause.
Thoracic aneurysms occur in the ascending aorta (25% of the time), the aortic arch (25% of the time), or the descending thoracic aorta (50% of the time).
Risk factors include various connective tissue disorders (such as Marfan's syndrome), Atherosclerosis, previous dissection of the aorta, prolonged hypertension, and trauma (usually falls or motor vechicle accidents).
Symptoms
Most patients have no symptoms until the aneurysm begins to leak or expand. Most non-leaking thoracic aortic aneurysms are detected by tests - usually a Chest x-ray or a chest CT scan - run for other reasons. Chest or back pain may indicate acute expansion or leakage of the aneurysm.
Signs and tests
The physical examination is often normal. A Chest x-ray and chest CT scan demonstrate enlargement of the aorta. A chest CT scan identifies the diameter of the aorta and the exact location of the aneurysm.
An aortogram (a special set of X-ray images made during injection of dye into the aorta) may also identify the location and extent of the aneurysm and identify any branch arteries of the aorta that are also involved.
Treatment
The treatment depends on the location of the aneurysm.
For patients with aneurysms of the ascending aorta or aortic arch, surgery to replace the aorta is recommended if the diameter of the aorta measures greater than 5-6 cm. The aorta is replaced with a fabric substitute in an operation that uses a heart-lung machine. If the aortic arch is involved, a specialized technique called "circulatory arrest" - a period without blood circulation while on life support - may be necessary.
Written and revised by
Gerald Hurowitz, M.D.
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