Thoracic Aortic Aneurysm and Aortic Dissection
What is a thoracic aortic aneurysm?
The aorta is the largest blood vessel in the body. It brings oxygenated blood from the heart to the rest of the body. An aortic aneurysm is a bulging, weakened area in the wall of the aorta. Over time, the blood vessel swells and is at risk for bursting (rupture) or separating (dissection). This can cause life-threatening bleeding and possibly death.
A thoracic aortic aneurysm occurs in the part of the aorta that runs through the chest. Aneurysms occur more often in the part of the aorta that runs through the belly or abdomen (abdominal aortic aneurysm).
Once formed, an aneurysm will slowly get larger and weaker. Treatment for a thoracic aneurysm may include surgery to fix or remove the aneurysm. Or a metal mesh coil (stent) may be inserted to support the blood vessel and prevent rupture.
What causes a thoracic aortic aneurysm?
Different diseases that can cause thoracic aortic aneurysms include:
- Degenerative disease that causes breakdown of the aortic wall tissue
- Genetic disorders
- Family history
- Plaque buildup (atherosclerosis)
- Infection (rare)
- Inflammation of the arteries (vasculitis)
- Uncontrolled hypertension
What are the symptoms of a thoracic aortic aneurysm?
Thoracic aortic aneurysms may not cause symptoms. When symptoms do occur, they may be related to the location and size, and how fast the aneurysm is growing.
Sudden, severe pain linked to a thoracic aneurysm may be a sign of a life-threatening medical emergency.
Symptoms of a thoracic aneurysm may include:
- Pain in the jaw, neck, or upper back
- Pain in the chest or back
- Pain that seems like a heart attack
- Wheezing, coughing, or shortness of breath caused by pressure on the trachea (windpipe)
- Hoarseness as a result of pressure on the vocal cords or nerves leading to the vocal cords
- Trouble swallowing due to pressure on the food pipe (esophagus)
The symptoms of a thoracic aortic aneurysm may look like other conditions. See your healthcare provider for a diagnosis.
How is a thoracic aortic aneurysm diagnosed?
Your healthcare provider will do a complete health history and physical exam. Other possible tests include:
- CT scan. This test uses X-rays and computer technology to make horizontal or axial images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard X-rays.
- MRI. This test uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
- Echocardiogram (also called echo). This test evaluates the heart’s structure and function. It uses sound waves recorded on an electronic sensor. This makes a moving picture of the heart and heart valves, as well as the structures within the chest. These include the lungs and the area around the lungs and the chest organs.
- Transesophageal echocardiogram (TEE). This test uses echocardiography to check for an aneurysm and check the heart valves. It can also see if there is a tear in the aorta lining. TEE is done by inserting a probe with a transducer on the end down the throat.
- Chest X-ray. This test uses invisible electromagnetic energy beams to make images of internal tissues, bones, and organs onto film.
- Arteriogram (angiogram). This is an X-ray image of the blood vessels that is used to assess conditions such as aneurysm, narrowing of the blood vessel, or blockages. A dye (contrast) is injected through a thin, flexible tube placed in an artery. The dye makes the blood vessels easy to see on an X-ray.
How is a thoracic aortic aneurysm treated?
Treatment may include:
- Monitoring with MRI or CT. These tests are done to check the aneurysm’s size and how fast it’s growing.
- Managing risk factors. Making some lifestyle changes may help control the progression of the aneurysm. These include quitting smoking, controlling blood sugar if you have diabetes, losing weight if overweight, controlling blood pressure, and eating a healthy diet.
- Medicine. Used to control factors such as high cholesterol or high blood pressure.
- Thoracic aortic aneurysm open repair. The type of surgery will depend on the location and type of aneurysm, and your overall health. For an ascending or aortic arch aneurysm, a large cut (incision) may be made through the breastbone. If an ascending aneurysm involves damage to the aortic valve of the heart, the valve may be fixed or replaced during the procedure. For a descending aneurysm, a large cut may be made. It may extend from the back under the shoulder blade, around the side of the rib cage, to just under the breast. This lets the surgeon see the aorta directly to fix the aneurysm.
- Endovascular aneurysm repair (EVAR). EVAR requires only small cuts in the groin. Using X-ray guidance and specially-designed tools, the surgeon can fix the aneurysm by inserting a metal mesh coil, called a stent-graft, inside the aorta. Not all thoracic aneurysms can be fixed with EVAR.
A small aneurysm or one that doesn't cause symptoms may not need surgery until it reaches a certain size. Or until it is quickly growing over a short time period. Your healthcare provider may recommend watchful waiting. This may include having a CT scan or MRI scan every 6 months to closely watch the aneurysm. Blood pressure medicine may be used to control high blood pressure.
If the aneurysm is causing symptoms or is large, your provider may recommend surgery.
What are the possible complications of a thoracic aneurysm?
A serious complication of a thoracic aortic aneurysm is an aortic dissection. This is a tear in the aortic lining. It can occur anywhere along the aorta. An aortic dissection starts with a tear in the inner layer of the aortic wall of the thoracic aorta. This can be a life-threatening emergency. The most common symptom of an acute aortic dissection is sudden severe, constant chest or upper back pain. This is sometimes described as ripping or tearing. The pain may move from one place to another.
An aortic aneurysm may burst. This is accompanied by blood in the chest. It is a life-threatening emergency
When a diagnosis of aortic dissection is confirmed, immediate surgery or stenting is often done. Talk with your provider about how you can manage your thoracic aortic aneurysm and reduce your risk for complications.
Key points about thoracic aortic aneurysm
- The aorta is the largest blood vessel in the body. An aortic aneurysm is a bulging, weakened area in the wall of the aorta.
- A thoracic aortic aneurysm occurs in the part of the aorta that runs through the chest.
- Treatment may include medicine, making lifestyle changes, monitoring with CT or MRI, and surgery.
- Sudden, severe pain linked to a thoracic aneurysm may be a sign of a life-threatening medical emergency.
- A serious complication is an aortic dissection. This is a tear in the aortic lining that can occur anywhere along the aorta. This can be a life-threatening emergency.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.