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Thoracic Aortic Aneurysm

Overview

Thoracic aortic aneurysm is a bulge in the upper part of the aorta, which is the major blood vessel that feeds blood to the entire body. A thoracic aortic aneurysm is sometimes referred to as thoracic aneurysm and aortic dissection (TAAD) because an aneurysm can lead to a tear in the wall of the artery (dissection) that can lead to life-threatening bleeding. Large, fast-growing aneurysms may rupture whereas small and slow-growing ones may not ever rupture. The size and growth rate of the thoracic aortic aneurysm determines the treatment. It may vary from watchful waiting to emergency surgery.

Symptoms

Thoracic aortic aneurysms are often asymptomatic and grow slowly thus making them difficult to detect. Many aneurysms start small and stay small, although many expand over time. The rate at which an aneurysm may grow is difficult to predict.

The most noticeable symptoms of thoracic aortic aneurysms are:

  • Pain or tenderness in the chest
  • Back pain
  • Hoarseness of voice
  • Cough
  • Shortness of breath

In most cases, aortic aneurysms do not have symptoms unless a tear (dissection) or rupture has occurred. When there is a rupture or dissection, it is a medical emergency that requires immediate hospitalization.

Indications if an aneurysm ruptures or one or more layers of the artery wall splits (dissection):

  • Sudden, sharp pain in the upper back radiating downward
  • Pain in the jaw, neck, arms, and chest
  • Breathlessness

Causes

The exact causes of thoracic aortic aneurysms are unknown. There are certain factors that contribute to development of aneurysms like:

  • Atherosclerosis (hardening if arteries) : This occurs when plaque builds up on the artery walls making them less flexible. The additional pressure causes them to weaken and bulge.
  • Connective tissue diseases : People who are born with Marfan syndrome which is a genetic condition that affects the connective tissue are at a high risk of developing thoracic aortic aneurysm. People with Marfan syndrome often have very distinct physical traits, such as tall stature, eye problems, very long arms, and a deformed breastbone.
  • Other medical conditions : Certain inflammatory conditions, such as giant cell arteritis and Takayasu's arteritis, are also factors that may cause thoracic aortic aneurysms.
  • Problems with the heart valves : People with aortic valve dysfunction have an increased risk of thoracic aortic aneurysm. This is especially true in cases where people have a bicuspid aortic valve (aortic valve has only two leaflets instead of three).
  • Traumatic injury : In some cases, people who are injured in falls or motor vehicle crashes can develop thoracic aortic aneurysms.

Risk factors

The risk factors for thoracic aortic aneurysm include:

  • Age : Thoracic aortic aneurysm is most often seen in people who are 65 years and older.
  • Tobacco use : Tobacco use is a very strong risk factor for developing aortic aneurysms. The longer the exposure, the greater the risk.
  • Blood pressure : Increase in blood pressure leads to damage of the blood vessels in the body thus increasing your chances of developing an aneurysm.
  • Atherosclerosis (plaque buildup in the arteries) : The plaque buildup in the form of fat and other substances can damage the lining of blood vessels increasing your risk of an aneurysm.
  • Family history : A family history of aortic aneurysms increases the risk of having aneurysms in individuals. They tend to develop aneurysms at a younger age with a higher risk of rupture.
  • Connective tissue disorders : This Connective tissue disorders, such as Marfan syndrome or Ehlers-Danlos syndrome indicate higher risk of a thoracic aortic aneurysm.

Complications

The main complications of thoracic aortic aneurysm are tears in the wall of the aorta (dissection) and rupture of the aorta. A ruptured aortic aneurysm can lead severe internal bleeding that is life-threatening. Larger the aneurysm, greater is the risk of rupture.

Indications that the thoracic aortic aneurysm has burst include:

  • Sudden, intense and persistent back or chest pain
  • Breathlessness
  • Low blood pressure
  • Loss of consciousness
  • Shortness of breath
  • Weakness, difficulty speaking, paralysis of one side of the body ,or other signs of stroke
  • Risk of blood clots. Small blood clots can develop in the area of the aortic aneurysm. These clots can break loose from the wall of an aneurysm and block a blood vessel causing serious complications.