A thoracic aortic aneurysm is an aneurysm (weakened area of artery that bulges or expands) that occurs in the upper chest (thoracic aorta). The thoracic aorta runs through the chest to the abdomen. The greatest concern with a thoracic aortic aneurysm is that it may rupture. Aneurysms that rupture can cause severe internal bleeding, which can be fatal. Caring for a thoracic aortic aneurysm is one of many offerings for vascular care at Ohio State.
While thoracic aortic aneurysms can occur, most aortic aneurysms occur in the abdomen.
Causes of thoracic aortic aneurysm
While the exact cause is unclear, a thoracic aortic aneurysm may be caused by multiple factors that damage the thoracic aortic wall:
- Atherosclerosis (hardening of the arteries) is thought to play an important role.
- Infection, injury to the thoracic aorta and genetic disorders, including Marfan syndrome, are also factors that increase the risk of developing a thoracic aortic aneurysm.
Other risk factors that contribute to include:
- Family history of aneurysms
- Being male
- Diabetes
- High blood pressure
- High cholesterol
- Older age (over 45 for women, over 55 for men)
- Smoking
Many of these risk factors can be reduced or eliminated by changing your lifestyle.
Aortic dissection is a condition that can also lead to thoracic aortic aneurysms. Dissection is linked to high blood pressure and occurs when blood flow forces a split in the layers of the aorta, weakening the aortic walls. Symptoms of a dissection include chest and/or back pain and can mimic a heart attack. If you experience symptoms, you should seek immediate medical care.
Screening
The Society of Vascular Surgery recommends a one-time ultrasound screening for women older than 65 who have smoked or have a family history of aneurysms. Men over age 65 or over age 55 if you have a family history of aortic aneurysms should also be screened.
Thoracic aortic aneurysm symptoms
Sadly, many people with this condition don't have symptoms until the aneurysm ruptures or bursts. In fact, a thoracic aortic aneurysm can develop, grow and go undetected for years. If there are symptoms they will depend on where the aneurysm is and its size. Symptoms may include:
- Pain in the jaw, neck, chest or upper back
- Coughing
- Hoarseness
- Difficulty breathing
If you do experience any of these symptoms do not ignore them. It is critical that you notify your physician immediately.
How Ohio State diagnoses thoracic aortic aneurysm
Your doctor may find signs of a thoracic aortic aneurysm during a routine medical exam. They are often found during tests being done for other medical conditions. Tests used to confirm the presence of a thoracic aortic aneurysm include:
- CT scan (computed tomography scan, also called CAT scan) – An imaging procedure that uses X-rays and computer technology to produce cross-sectional, detailed images of the body, including bones, muscles, fat and organs
- Echocardiogram – This test takes picture of the heart to determine how well it's functioning, evaluate heart valves and measure the size of part of the thoracic aorta.
- MRI (magnetic resonance imaging)– A noninvasive, sophisticated imaging procedure that uses large magnets and a computer to produce detailed images of organs and structures inside the body
- Ultrasound – A test that uses high-frequency sound waves to evaluate blood flow in a vessel
Thoracic aortic aneurysm treatment
Treatment of a thoracic aortic aneurysm depends on its size. If it is small and you are not experiencing symptoms, your physician may recommend monitoring its size and the development of symptoms. The goal is to prevent the aneurysm from ever rupturing. Medication to control high blood pressure and to lower cholesterol may be prescribed. Surgery may also be indicated.
There are generally two types of aneurysm repair surgeries:
- Endovascular repair makes use of a catheter that guides a stent graft through small incisions in the groin. The graft is inserted into the aneurysm and seals the aneurysm from within.
- Open surgical repair may be recommended if the aneurysm anatomy does not allow for endovascular repair. In this procedure, the damaged area is removed and replaced with a graft.
A ruptured aneurysm is a very dangerous condition. Although it is possible to repair a ruptured aneurysm surgically, it is important to identify and treat aneurysms before a rupture occurs.