Clinical manifestations and diagnosis of thoracic aortic aneurysm
- Y Joseph Woo, MD
Y Joseph Woo, MD
- Department Chair, Cardiothoracic Surgery
- Stanford University
- Emile R Mohler III, MD
Emile R Mohler III, MD
- Section Editor — Vascular Medicine
- Professor of Medicine
- University of Pennsylvania School of Medicine
- Christina L Greene, MD
Christina L Greene, MD
- Cardiothoracic Surgery Resident
- Stanford University
- Section Editors
- Catherine M Otto, MD
Catherine M Otto, MD
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Cardiac Evaluation; Valvular Disease
- Professor of Medicine
- University of Washington
- James Hoekstra, MD
James Hoekstra, MD
- Section Editor — Adult Cardiology Emergencies
- Professor and Fredrick Glass Chair
- Wake Forest University
- John F Eidt, MD
John F Eidt, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor of Surgery, Texas A&M Health Science Center
- Vice Chair of Vascular Surgical Services, Baylor Heart and Vascular Hospital at Dallas
- Joseph L Mills, Sr, MD
Joseph L Mills, Sr, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor and Chief
- Division of Vascular Surgery and Endovascular Therapy
- Baylor College of Medicine
Complications of aortic aneurysmal disease (thoracic and abdominal) are a leading cause of death in the United States, particularly in individuals aged >55 years . Thoracic aortic aneurysm (TAA) represents approximately one-third of aortic aneurysm admissions, with the remainder of cases related to abdominal aortic disease . The prevalence of thoracic aortic aneurysms (TAAs) is lower than the reported prevalence of abdominal aortic aneurysms (AAAs), but unlike AAA, which appears to be decreasing, the incidence of TAA is increasing. Enlargement of the thoracic aorta is an increasingly recognized condition that is diagnosed incidentally on imaging studies performed to evaluate unrelated conditions.
Most patients with TAA have no symptoms. Aneurysms that produce symptoms are typically very large and are at an increased risk for rupture, which is associated with high mortality rates. When symptoms do occur, patients can present with chest or upper back pain, or with symptoms related to compression of surrounding structures leading to nerve dysfunction, or arterial compression causing ischemia or thromboembolism.
This topic will review the clinical features and diagnosis of TAA. Pseudoaneurysm (false aneurysm), represents a collection of blood and connective tissue outside the aortic wall, the result of a contained aortic rupture, which may be due to one of a variety of pathologic processes such as penetrating aortic ulcer, aortic dissection, blunt aortic injury, or other acute aortic syndromes. These disorders are discussed elsewhere. (See "Overview of acute aortic syndromes" and "Overview of acute aortic syndromes", section on 'Definition and pathophysiology'.)
The management and outcome of TAA and AAA are discussed separately. (See "Management of thoracic aortic aneurysm in adults" and "Overview of abdominal aortic aneurysm".)
Anatomy of the thoracic aorta — The aorta is the major arterial conduit conveying blood from the heart to the systemic circulation. It originates immediately beyond the aortic valve and ascends initially, then it curves, forming the aortic arch, and descends caudally adjacent the spine. The ascending thoracic aorta gives off the coronary arteries, and the aortic arch branches are typically the brachiocephalic trunk (branches to the right carotid and right subclavian arteries), left carotid and left subclavian arteries; however, aortic arch anatomy can vary (figure 1). The descending thoracic aorta provides paired thoracic arteries (T1-T12) and continues through the hiatus of the diaphragm (figure 2A-B) to become the abdominal aorta, which extends retroperitoneally to its bifurcation into the common iliac arteries at the level of the fourth lumbar vertebra.
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- ANATOMIC ISSUES
- Anatomy of the thoracic aorta
- Definition of TAA
- CLINICAL PRESENTATIONS
- Asymptomatic TAA
- - Biomarkers of thoracic aortic disease
- - Clinical markers of thoracic aortic disease
- Symptomatic TAA
- - Rupture
- - Laboratory studies
- - ECG findings
- PHYSICAL EXAMINATION
- IMAGING DIAGNOSIS
- Incidental TAA
- Imaging asymptomatic, high-risk patients
- Imaging symptomatic patients
- Choice of imaging technique
- - Imaging standards
- DETERMINING TAA ETIOLOGY
- Sporadic versus genetically-mediated
- Syndromic versus nonsydromic
- DIFFERENTIAL DIAGNOSIS
- SUMMARY AND RECOMMENDATIONS