Thoracic Aortic Aneurysms

Question 2

What is a thoracic aortic aneurysm?

Answer 2

Aneurysm involving the aortic arch, ascending aorta or descending aorta

Question 3

What is the aetiology of a thoracic aortic aneurysm?

Answer 3

Degradation of the tunica media that normally provides tensile strength and elasticity

Artery loses structural integrity and dilates

Usually due to connective tissue diseases (EDS and Marfan’s) or Bicuspid aortic valve

Question 4

What are the risk factors for a thoracic aortic aneurysm?

Answer 4

• FHx
• Hypertension
• Atherosclerosis (especially descending aneurysms)
• Smoking
• High BMI
• Male gender
• Advancing age

Question 5

What are the clinical features of a thoracic aortic aneurysm?

Answer 5

• Often asymptomatic and found incidentally
• See image for pain

- Back pain from spinal compresion by descending aorta

- Hoarse voice due to left reccurent laryngeal nerve damage in arch aneurysm

- Distended neck veins if SVC compression

- Symptoms of heart failure if aortic valve involved

- Dyspnoea if tracheal/bronchial compression

Question 6

What is acute aortic syndrome and how does it present?

Answer 6

Acute painful and potentially life-threatening aortic pathologies that require immediate medical attention

Include: aortic dissection, aortic ulcer, intramural hematoma and unstable thoracic aortic aneurysm

Symptoms: sudden onset pain in back, chest, neck and/or abdomen

Question 7

How are thoracic aneurysms investigated?

Answer 7

Initial: routine bloods (FBC, U+Es, clotting), ECG, CXR

Imaging: often found incidentally on CXR with widened mediastinal silhouette, enlarged aortic knob and possible tracheal deviation

- CT chest scan with contrast

- Transoesophageal echocardiography

Question 8

How are thoracic aortic aneurysms managed?

Answer 8

Medical (initially)

• Start on aspirin and statin to reduce risk of MI
• Control BP
• Smoking cessation

Surgical (depends on location of aneurysm)

• See image for criteria
• Lower threshold for Marfan’s and previous thoracic dissection

Question 9

What is the prognosis with a thoracic aortic aneurysm?

Answer 9

• Risk of rupture or dissection
• Development of second aneurysm common so imaging studies following surgery e.g MRI or CT