Thoracic Aortic Aneurysm

Overview, Causes, & Risk Factors

An aneurysm is an abnormal widening of a blood vessel. In this case, the blood vessel is in the aorta. This is the main blood vessel that supplies blood to the rest of the body. The thoracic aorta is the part of the aorta that travels through the chest.

What is going on in the body?

A weakening of the wall of the aorta can cause it to widen or swell. The larger the aneurysm, the more pressure it puts on the nearby tissues and the greater the risk of rupture. An artery that ruptures or bursts open is an emergency that often causes death.

What are the causes and risks of the disease?

Causes of thoracic aortic aneurysm include:

hardening and narrowing of the arteries, known as atherosclerosis

genetic diseases that cause weakness of the tissues that make up the aorta

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other infections or inflammation of the aorta

chest trauma, such as a crush injury

In many cases, the cause is not known.

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Symptoms & Signs

What are the signs and symptoms of the disease?

Many people have no symptoms. A thoracic aortic aneurysm may be found accidentally as part of the testing for another problem. When symptoms do occur, may they include:

chest pain, neck pain, or back pain

coughing and shortness of breath, due to pressure on the windpipe or congestive heart failure

difficulty swallowing, due to pressure on the food tube, called the esophagus

a hoarse voice, due to pressure on a nerve in the neck

a small pupil and droopy eyelid on one side of the face, known as ptosis. These changes are caused by pressure on a different nerve in the neck.

swelling in the neck and arms, due to pressure on other major blood vessels

The healthcare provider may detect the abnormal eye findings or a change in the position of the windpipe. He or she may also be able to hear a heart murmur during a physical exam if the condition has affected a valve in the heart.

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Diagnosis & Tests

How is the disease diagnosed?

A thoracic aortic aneurysm can sometimes be seen on a regular chest x-ray. Other special x-ray tests, such as a chest CT scan, are used to detect and measure the size of the aneurysm.

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Prevention & Expectations

What can be done to prevent the disease?

Many times nothing can be done to prevent a thoracic aortic aneurysm. Cases due to Treponema pallidum\ bacteria. Less often, syphilis is transmitted from a pregnant woman to her baby. This form of syphilis is known as \congenital syphilis.\ ',CAPTION,'Syphilis');" onmouseout="return nd();">syphilis can be prevented with proper treatment early in the course of the disease. Reducing coronary risk factors can often prevent cases due to atherosclerosis. This includes not smoking and controlling high blood pressure, diabetes, and high cholesterol, if present.

What are the long-term effects of the disease?

Many people with a thoracic aortic aneurysm have no symptoms for many years. However, the long-term effects can be quite serious, and include:

congestive heart failure

heart attack

blood clots

sudden death

Death is usually due to sudden rupture of the aneurysm. The size and underlying cause of this condition primarily determine the risk of rupture.

What are the risks to others?

A thoracic aortic aneurysm is not contagious and poses no risk to others.

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Treatment & Monitoring

What are the treatments for the disease?

Mild forms of a thoracic aortic aneurysm, especially in those who cannot tolerate major surgery for health reasons, are treated with heart and blood pressure medications. These individuals are watched closely and sent for surgery only if needed.
Surgery is the treatment of choice if the aneurysm is bigger than 5 to 6 centimeters, or roughly 2 inches wide. Surgery involves replacing the abnormal part of the aorta with an artificial graft. In some cases, one of the heart valves may also need to be repaired or replaced. The decision to perform surgery partly depends on the underlying cause of the condition. The risks and benefits of surgery should be discussed with the surgeon. Treatment is tailored to the needs of each person.
If the aneurysm ruptures, most people die within a few minutes. Those who survive are generally taken quickly to surgery to prevent death.

What are the side effects of the treatments?

All medications have possible side effects including allergic reactions. Specific side effects depend on the medications used.
Surgery is associated with a risk of bleeding, infections, and death. Paralysis, life-threatening blood clots, and allergic reactions to anesthesia are also possible.

What happens after treatment for the disease?

A person with a thoracic aortic aneurysm that is being treated only with medications needs regular office visits to follow the condition. Any new or worsening symptoms should be reported to the healthcare provider immediately.
If surgery is done, a period of recovery is required. The surgery is a major operation associated with many risks, but it is done to prevent death. After recovery, the person will be closely observed for leakage from the artificial graft.

How is the disease monitored?

After surgery, a person will need to see the healthcare provider for regular visits. Someone who is treated only with medications will often have repeated special x-ray tests to watch for an increase in aneurysm size.

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Attribution

Author:Eric Berlin, MD
Date Written:
Editor:Smith, Elizabeth, BA
Edit Date:06/29/00
Reviewer:Adam Brochert, MD
Date Reviewed:05/07/01

Sources

Merck Manual, 1999
Harrison's Principles of Internal Medicine, 1991
Current Medical Diagnosis and Treatment, 1996

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