Thoracic Aneurysm Clinical Presentation

  • Author: Bret P Nelson, MD; Chief Editor: David FM Brown, MD   more...
 
Updated: Sep 1, 2011
 

History

Patients with thoracic aortic aneurysm (TAA) may be asymptomatic. Forty percent may be found incidentally during workup for other processes. Symptoms vary according to the size, location, and changes in the aneurysm. Chest, back, and abdominal pain are common symptoms in patients who are symptomatic.

  • Aortic root dilatation may lead to symptoms of congestive heart failure (CHF) due to aortic insufficiency.
  • Hoarseness may signify vagus or recurrent laryngeal nerve compression.
  • Wheezing, dyspnea, or cough suggests tracheal compression. Hemoptysis may be a sign of aneurysmal erosion into the trachea.
  • Dysphagia, hematochezia, or hematemesis may be caused by esophageal compression or aortoesophageal fistula.
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Physical

  • The physical examination findings are usually normal.
  • Ruptured thoracic aneurysm may cause hypotension, tachycardia, and shock.
  • An early diastolic murmur may be heard in patients with aortic root dilatation causing aortic insufficiency.
  • Wheezing or cough suggests compression of the trachea, and hemoptysis may be a sign of aneurysm erosion into the trachea.
  • Dysphagia, hematochezia, or hematemesis may be caused by esophageal compression or aortoesophageal fistula.
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Causes

  • Although atherosclerotic disease is often present in patients with thoracic aortic aneurysm (TAA), it may only play a minor causal role in the pathogenesis of aneurysm development.
  • Aortic aneurysm is often associated with smoking and hypertension.
  • Marfan syndrome and Ehlers-Danlos syndrome are associated with an increased incidence of TAA and dilatation of the aortic root.
  • Aortic aneurysm has been associated with a number of rheumatologic disorders, such as giant cell arteritis, Takayasu arteritis, and psoriatic arthritis.
  • Syphilitic aortitis is an increasingly uncommon cause of thoracic aneurysm.
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Contributor Information and Disclosures
Author

Bret P Nelson, MD  Associate Professor of Emergency Medicine, Director of Emergency Ultrasound, Department of Emergency Medicine, Mount Sinai School of Medicine

Bret P Nelson, MD is a member of the following medical societies: American College of Emergency Physicians, American Institute of Ultrasound in Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Theodore I Benzer, MD, PhD  Assistant Professor in Medicine, Harvard Medical School; Director of Clinical Operations, Director of Toxicology, Chair of Quality and Safety, Department of Emergency Medicine, Massachusetts General Hospital

Theodore I Benzer, MD, PhD is a member of the following medical societies: Alpha Omega Alpha and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Eric M Isselbacher, MD  Associate Professor of Medicine, Harvard Medical School; Associate Director, Massachusetts General Hospital Heart Center; Co-Director, Thoracic Aortic Center, Massachusetts General Hospital

Eric M Isselbacher, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, American Society of Echocardiography, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Edward Bessman, MD  Chairman, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine

Edward Bessman, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gary Setnik, MD  Chair, Department of Emergency Medicine, Mount Auburn Hospital; Assistant Professor, Division of Emergency Medicine, Harvard Medical School

Gary Setnik, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: SironaHealth Salary Management position; South Middlesex EMS Consortium Salary Management position; ProceduresConsult.com Royalty Other

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

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  11. Glade GJ, Vahl AC, Wisselink W, et al. Mid-term survival and costs of treatment of patients with descending thoracic aortic aneurysms; endovascular vs. open repair: a case-control study. Eur J Vasc Endovasc Surg. Jan 2005;29(1):28-34. [Medline].

  12. Guo DC, Papke CL, He R, Milewicz DM. Pathogenesis of thoracic and abdominal aortic aneurysms. Ann N Y Acad Sci. Nov 2006;1085:339-52. [Medline].

  13. Leurs LJ, Bell R, Degrieck Y, et al. Endovascular treatment of thoracic aortic diseases: combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries. J Vasc Surg. Oct 2004;40(4):670-9; discussion 679-80. [Medline].

  14. Pressler V, McNamara JJ. Aneurysm of the thoracic aorta. Review of 260 cases. J Thorac Cardiovasc Surg. Jan 1985;89(1):50-4. [Medline].

  15. Safi HJ, Miller CC. Thoracic vasculature. In: Townsend CM, Beauchamp DR, Evers MB, et al, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 16th ed. Philadelphia, Pa: WB Saunders Co; 2001.

 
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Descending thoracic aortic aneurysm with mural thrombus at the level of the left atrium.
 
 
 
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