Thoracic aortic aneurysm

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Thoracic aortic aneurysm
Synonyms	Thoracic aneurysm
Pronounce	N/A
Specialty	N/A
Symptoms	Often none, but may include chest pain, back pain, cough, shortness of breath
Complications	Aortic dissection, aortic rupture
Onset	Typically in adults over 50
Duration	Long-term
Types	N/A
Causes	Atherosclerosis, genetic disorders (e.g., Marfan syndrome, Ehlers-Danlos syndrome), trauma
Risks	Hypertension, smoking, family history
Diagnosis	CT scan, MRI, echocardiography
Differential diagnosis	Aortic dissection, pulmonary embolism, myocardial infarction
Prevention	Blood pressure control, smoking cessation
Treatment	Surgery, endovascular aneurysm repair (EVAR), beta blockers
Medication	N/A
Prognosis	Variable, depends on size and growth rate
Frequency	10 per 100,000 people per year
Deaths	Approximately 15,000 per year in the United States

Aneurysm of the thoracic aorta is called thoracic aortic aneurysm. A thoracic aortic aneurysm is an abnormal dilation or bulging of the aorta in the thoracic region. The condition presents a significant medical concern, as it may result in life-threatening complications such as aortic rupture or dissection.

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Types of Thoracic Aortic Aneurysm

Depending on its anatomical location, a thoracic aortic aneurysm can be classified into several categories:

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• Aneurysm of the Ascending Aorta: Involves the portion of the aorta that rises from the heart.
• Aneurysm of the Descending Aorta: Affects the part of the aorta that descends through the thoracic cavity.

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Risk Factors

A variety of factors may increase the risk of developing a thoracic aortic aneurysm:

• Age: Older individuals are more prone to aneurysms.
• Smoking: A significant risk factor due to its detrimental effects on blood vessels.
• Gender: Men are generally at a higher risk than women.
• Genetic Factors: Family history may play a role.
• Connective Tissue Diseases: Conditions like Marfan syndrome are associated with aortic aneurysms.
• Infectious Diseases: Such as syphilis.
• Traumatic Injuries: Direct trauma to the chest can sometimes result in an aneurysm.

Symptoms of Thoracic Aortic Aneurysm

Aneurysms usually evolve gradually and may not produce symptoms until they are at an advanced stage. However, certain circumstances may prompt the onset of symptoms:

Sudden Onset Symptoms

• Rapid enlargement of the aneurysm
• Rupture
• Aortic dissection
• Leaking of blood along the wall of the aorta

Symptoms Due to Compression of Nearby Structures

• Hoarseness
• Difficulty swallowing
• Stridor (high-pitched breathing)
• Neck swelling

Additional Symptoms

• Chest or upper back pain
• Clammy skin
• Nausea and vomiting
• Rapid heart rate
• Sense of impending doom

Diagnostic Methods

Diagnosis typically begins with a physical examination, although imaging tests are usually necessary for confirmation:

• Chest X-ray
• Echocardiogram
• Chest CT Scan or MRI
• Aortogram: A specialized X-ray utilizing contrast dye

Treatment Options

The treatment of thoracic aortic aneurysms varies based on the location and severity:

Ascending Aorta or Aortic Arch Aneurysms

• Open-chest surgery using a synthetic or fabric graft.
• Heart-lung machine is required for this major operation.

Descending Thoracic Aorta Aneurysms

• Major surgery to replace the affected segment with a fabric graft.
• Endovascular stenting: A less invasive option using a stent to reinforce the artery. Not suitable for all patients.

Prognosis

The long-term outlook is influenced by several variables such as concurrent medical conditions like heart disease, high blood pressure, and diabetes.

Potential Complications

• Bleeding
• Graft infection
• Heart attack
• Arrhythmias
• Kidney failure
• Paralysis
• Stroke
• Death (5-10% surgical mortality rate)

When to Seek Medical Attention

Consult a healthcare provider if you experience symptoms or have a family history of aneurysms or connective tissue disorders. Preventive measures for atherosclerosis can also help mitigate the risk.

See Also

• Abdominal aortic aneurysm
• Marfan syndrome
• Aortic dissection
• Vascular surgery
• Cardiovascular diseases

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