Thoracic Aneurysm Clinical Presentation

Updated: Oct 01, 2015
  • Author: Bret P Nelson, MD; Chief Editor: Erik D Schraga, MD  more...
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Presentation

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. Note the following:

  • 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. Note the following:

  • 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. Note the following:

  • 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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