Aortic Pathology

Question 1

What is an aneurysm?

Answer 1

abnormal dilation of artery or vein that develops where there is a weakening of the wall of a vessel due to congenital defects, infections, trauma, or systemic diseases.

Question 2

Where do most atherosclerotic aortic aneurysms occur?

Answer 2

below the level of the renal arteries.

Question 3

What is characteristic of atherosclerotic aortic aneurysms?

Answer 3

often have thrombus formation on the wall and these thrombi may form emboli :(

Question 4

What are some things that abdominal aortic aneurysms may do as they grow?

Answer 4

• occlude the iliac, renal, or mesenteric arteries
• erode into vertebral bodies
• dissect= tear in the inner layer
• form a pulsatile mass

Question 5

How can tertiary syphilis affect the aorta (syphilitic aortitis)?

Answer 5

causes narrowing of the vasa vasorum which supplies oxygen to the aortic media (usually ascending and transverse portions; thoracic). This causes longitudinal “tree barking” where the intima starts to become wrinkled, leading to secondary atherosclerotic involvement.
As it proceeds proximally it may involve the aortic valve leading to incompetence of the valve and subsequent left ventricular hypertrophy.

Question 6

With what symptoms may pts with syphilitic aortitis present?

Answer 6

respiratory difficulties (dyspnea), difficulty swallowing (dysphagia), cough from pressure on the recurrent laryngeal nerve, pain from erosion of bone and may have cardiac disease.

Question 7

What is an aortic dissection?

Answer 7

little tear in the intima usually caused by hypertension, allowing blood to enter into the media and expand along the walls of the vessel.

Question 8

In what age group and sex do aortic dissections occur most?

Answer 8

men aged 40-60 with hypertension.

Question 9

What 2 syndromes are associated with aortic dissections?

Answer 9

1. Marfan syndrome= fibrillin defect with cystic medial necrosis
2. Ehlers-Danlos syndrome
   * Both occur within 10 cm. of aortic vavle

Question 10

What is a hemopericardium?

Answer 10

hemorrhage dissects proximally to aortic valve and into pericardium.

Question 11

What is a double-barreled aorta?

Answer 11

hemorrhage ruptures back into the aortic lumen

Question 12

What are the two types of aortic dissections?

Answer 12

• Type A= involves ascending aorta and is most common and most dangerous.
• Type B= dow not involve the ascending aorta.

Question 13

What are the symptoms of aortic dissection?

Answer 13

sudden onset of tearing chest and back pain. Can mimic MI.

Question 14

What will you see on chest x-ray with aortic dissection?

Answer 14

widened mediastinum