Thoracic Aortic Aneurysm

What is thoracic aortic aneurysm?

The aorta is the large blood vessel in the chest that leaves the heart and delivers blood to the rest of the body. A thoracic aortic aneurysm is a bulge in the wall of the aorta.

If thoracic aortic aneurysms are severe enough to cause symptoms, you may experience severe chest or back pain, shortness of breath, coughing or wheezing, difficulty swallowing, hoarseness, numbness or weakness in one or both arms, and loss of consciousness or low blood pressure.

Treatments include careful monitoring, medications to control blood pressure or cholesterol, and surgery.

Call 911 immediately.

Thoracic aortic aneurysm symptoms

Most thoracic aortic aneurysms are asymptomatic unless they are a more severe type due to a dissection (when a tear develops between the layers of an artery) or a rupture (when the wall of an artery tears completely). Therefore, when they do cause symptoms, this usually indicates a dangerous and potentially life-threatening condition.

Chest-related symptoms

Chest-related symptoms include:

Severe chest or back pain: Chest pain or back pain can gradually become severe as the thoracic aortic aneurysm grows and pushes on surrounding structures such as the spine. Pain can also occur suddenly if the thoracic aortic aneurysm dissects or ruptures.

Shortness of breath, coughing, or wheezing: Shortness of breath can occur if expansion of the aorta causes blood to leak backward from the heart to the lungs. Shortness of breath as well as coughing or wheezing (a whistling sound heard when breathing out) also can occur if the aneurysm grows bigger and presses on the lungs or the pipes going to/from the lungs.

Other symptoms

Beyond chest-related symptoms, you may also experience:

• Difficulty swallowing: A thoracic aortic aneurysm can cause difficulty swallowing if it grows large enough to press on the esophagus, which is the muscular tube that connects the mouth to the stomach.
• Hoarseness: If the thoracic aortic aneurysm gets large enough to push on a nearby nerve that helps the vocal cords function properly, the voice may become hoarse.
• Numbness or weakness in one or both arms: If the thoracic aortic aneurysm compresses one of the blood vessels that branches off the aorta to provide blood to the arms, one or both arms may become weak or numb.
• Loss of consciousness and low blood pressure: If a thoracic aortic aneurysm ruptures, it can cause very low blood pressure and a loss of consciousness. This occurs because blood is leaking out of the ruptured aorta and is not getting to the rest of the body. This is an emergency that needs to be treated right away.

Causes of thoracic aortic aneurysm

Thoracic aortic aneurysms are rare, occurring in six to 10 people per 100,000. About 20 percent of cases are related to family history. There are a number of causes and risk factors for developing a thoracic aortic aneurysm such as atherosclerosis, aortic inflammation, genetic syndromes, and genetic mutations.

Atherosclerosis of the blood vessels

Most cases of thoracic aortic aneurysm occur when fatty plaques build up on the walls of blood vessels, in a process known as atherosclerosis. Over time, this can weaken the walls of blood vessels such as the aorta and lead to an aneurysm. Risk factors for atherosclerosis include:

• Smoking
• High blood pressure
• High cholesterol levels

Inflammation of the aorta

Inflammation can weaken the walls of the aorta and cause a thoracic aortic aneurysm. Certain infections such as the following may be causes.

• Late stage syphilis: This can cause inflammation of the aorta.
• Vasculitides: This is an autoimmune disorder involving inflammation of blood vessels.
• Lupus: Another autoimmune disorder.

Genetic syndromes

Certain genetic syndromes can cause a thoracic aortic aneurysm to develop. These syndromes involve abnormalities in connective tissue, which may cause stretchy skin or flexible joints. These syndromes include:

• Marfan syndrome
• Ehlers-Danlos syndrome
• Loeys-Dietz syndrome
• Turner syndrome

Genetic mutations

Some cases of thoracic aortic aneurysm are caused by specific genetic mutations that are not associated with another syndrome. These mutations will usually cause thoracic aortic aneurysm that runs in families.

Treatment options and prevention

A thoracic aortic aneurysm is a chronic condition that develops over time but can suddenly lead to severe and dangerous symptoms if a complication occurs. Therefore, treatments are focused on both examining risks for complications and treating complications if they occur. Specific thoracic aortic aneurysm treatments include monitoring, medications, and surgery.

Monitoring

If you are diagnosed with a thoracic aortic aneurysm, you should regularly see your physician to have your aneurysm evaluated. Your physician will:

• Order imaging studies: Such as a chest X-ray or CT scan to determine the size of the aneurysm
• Track how quickly it is growing over time
• Recommend treatments if needed

Medications to control blood pressure

If your thoracic aortic aneurysm is not causing symptoms, your physician may recommend medications to control blood pressure.

• Types: Specific medications may include propranolol (Inderal) or losartan (Cozaar), among others.
• Efficacy: Controlling blood pressure may reduce the rate at which your thoracic aortic aneurysm expands.

Medications to lower cholesterol levels

If your thoracic aortic aneurysm is not causing symptoms, your physician may recommend medications to lower cholesterol levels.

• Types: The medications used are usually statins, such as atorvastatin (Lipitor) or rosuvastatin (Crestor).
• Efficacy: Lowering cholesterol may reduce atherosclerosis, which can weaken the wall of the aorta and other blood vessels.

Surgery to repair the thoracic aortic aneurysm

When the thoracic aortic aneurysm gets large enough to cause a significant risk of rupture, your physician may recommend surgery to repair the aneurysm. This can include:

• Emergency life-saving surgery: This will be needed if your thoracic aortic aneurysm develops a dissection or a rupture.
• Open surgery: Performed through the chest
• Endovascular surgery: Performed through the blood vessels

When to seek further consultation

You should seek medical attention if you develop symptoms or are aware of a family history of thoracic aortic aneurysms.

If you develop any symptoms of thoracic aortic aneurysm

You should go to your physician right away if you experience chest or back pain, trouble breathing, difficulty swallowing, or hoarseness, or go straight to the emergency department if the pain is sudden or severe.

If you have a genetic syndrome that increases risk of having a thoracic aortic aneurysm

You can consider seeing your physician if you have Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome, or Turner syndrome. He or she may order an imaging test to see if you have a thoracic aortic aneurysm.

If you have a family member who had a thoracic aortic aneurysm or a complication

You should see your physician. He or she may order an imaging test to see if you also have a thoracic aortic aneurysm.