Thoracic Aortic Aneurysm

A thoracic aortic aneurysm is a bulge or weakness in a major blood vessel in your chest called the aorta. This is the large artery that carries blood from your heart to the rest of your body. The aorta has layers, and when these layers weaken, the artery can widen in a specific area. This widening is called an aneurysm. Sometimes, people use the shorter term "thoracic aneurysm" to refer to this.

These weakened areas can happen anywhere along the aorta, but a thoracic aneurysm happens in the upper part of the aorta, in the chest.

How a thoracic aneurysm is treated depends on several factors. Doctors might recommend regular checkups to monitor the situation, or, if the aneurysm is large, growing quickly, or causing problems, surgery might be necessary. The decision about the best treatment depends on the cause of the weakening, the size of the bulge, and how fast it's growing.

If left untreated, a thoracic aneurysm can be dangerous. A possible complication is a rupture—a tear in the artery wall. Another serious complication is an aortic dissection, which is a tear between the layers of the aorta's wall. Both of these can be life-threatening and lead to sudden death.

Thoracic aortic aneurysms aren't as common as abdominal aortic aneurysms, which occur in the lower part of the aorta.

Thoracic aortic aneurysms are bulges in a major blood vessel in your chest. Often, these bulges develop slowly and don't cause any noticeable problems. Many aneurysms stay small and cause no issues. Others gradually get bigger. It's hard to know how fast an aneurysm will grow.

As a thoracic aortic aneurysm grows, you might start to experience some symptoms. These can include:

• Back pain: This pain may be a general ache or a sharper discomfort.
• Cough: A persistent cough can be a sign.
• Hoarse voice: A change in your voice, making it sound weak or scratchy, could indicate a problem.
• Shortness of breath: Difficulty breathing can be a warning sign.
• Chest pain or tenderness: Pain or soreness in your chest could be related to the aneurysm.

If the aneurysm ruptures or tears (called a dissection), symptoms change and become more serious. These include:

• Sudden, severe back pain: This pain often starts in the upper back and spreads down.
• Pain in the chest, jaw, neck, or arms: Pain radiating to these areas is a sign of potential rupture or dissection.
• Trouble breathing: Difficulty catching your breath is a serious symptom.
• Low blood pressure: A dangerously low blood pressure is a sign of a serious internal problem.
• Loss of consciousness: Passing out is a very serious symptom.
• Trouble swallowing: Difficulty swallowing can be a sign of pressure on the esophagus.

Importantly, not all aneurysms rupture or dissect. Most people with a thoracic aortic aneurysm won't experience any symptoms at all until the aneurysm bursts or tears. If you think you might have a thoracic aortic aneurysm, or if you experience any of the sudden, severe symptoms listed above, seek immediate medical attention. Call 911 or your local emergency number immediately. This is a medical emergency.

Aortic aneurysms are often silent. This means most people don't experience any problems until the aneurysm bursts or tears. A tear or rupture of the aorta is a serious medical emergency. If you suspect a problem, immediately call 911 or your local emergency number.

Aortic aneurysms happen when a section of the aorta, the large blood vessel that carries blood from the heart to the rest of the body, weakens and bulges outwards. This can happen anywhere along the aorta, which runs from the heart through the chest and abdomen. A bulge in the chest part of the aorta is called a thoracic aortic aneurysm. If the bulge is in the part of the aorta connecting the upper and lower chest, it's called a thoracoabdominal aneurysm. The bulge can be round or tube-like. It can develop near the heart, in the arch of the aorta, or further down in the chest.

Several things can cause an aortic aneurysm:

• Genetics: Aortic aneurysms in younger people are sometimes linked to inherited conditions. For example, Marfan syndrome weakens the tissues that support the aorta, making it more prone to bulging. Other conditions like vascular Ehlers-Danlos syndrome, Loeys-Dietz syndrome, and Turner syndrome can also increase the risk.

• Inflammation of the blood vessels: Conditions that cause inflammation in the blood vessels, such as giant cell arteritis and Takayasu arteritis, can weaken the aorta and lead to aneurysms.

• Aortic valve problems: The aortic valve controls blood flow from the heart to the aorta. If a person is born with an aortic valve that has only two flaps instead of the normal three, this can increase their risk of an aneurysm.

• Infections: Though rare, untreated infections like syphilis or salmonella can sometimes contribute to an aneurysm.

• Injury: In rare cases, a traumatic injury, such as from a fall or car accident, can cause an aortic aneurysm.

Imagine the aorta's wall like a balloon. An aneurysm forms when a spot on the balloon wall weakens and bulges outward. A bulge in the aorta increases the risk of a tear in the lining of the aorta, called an aortic dissection. This is like a rip in the balloon, allowing blood to leak into and along the aorta's wall. In some cases, the blood leak can travel completely outside the aorta, creating an aortic rupture.

Aortic dissection is a serious medical emergency, and the location of the tear significantly affects the severity of the situation. Treatment for an aortic aneurysm aims to prevent a dissection. If a dissection does occur, surgery can still be an option, but the patient will likely have a higher chance of complications. Early diagnosis and treatment are crucial to managing aortic aneurysms and minimizing the risk of life-threatening complications.

A thoracic aortic aneurysm, a bulge in the main artery of the chest, can be caused by several things. One major factor is age. The risk increases as you get older, and most cases happen to people 65 and older.

Smoking and other forms of tobacco use significantly raise the chances of developing an aortic aneurysm. Nicotine damages blood vessels, making them more prone to weakening and bulging.

High blood pressure is another risk factor. High pressure constantly pushes against the artery walls, gradually wearing them down and increasing the risk of an aneurysm.

Plaque buildup in the arteries is also a concern. Over time, deposits of fat and other substances can accumulate inside the artery walls, further weakening them and making an aneurysm more likely. This is often a problem for older people.

Family history plays a role. If a close relative, like a parent, sibling, or child, has had an aortic aneurysm, you have a higher risk yourself. You might even develop one at a younger age than average.

Certain genetic conditions increase the risk dramatically. People with Marfan syndrome, Loeys-Dietz syndrome, or vascular Ehlers-Danlos syndrome are particularly vulnerable to aortic aneurysms, along with other related problems like dissections (tears in the artery) or ruptures.

Finally, having a bicuspid aortic valve (a valve with two flaps instead of three) can also slightly increase the risk of a thoracic aortic aneurysm.

A thoracic aortic aneurysm is a bulge in a major blood vessel in the chest. Sometimes, this bulge can weaken and tear, or rupture. This is a serious problem, and one of the most dangerous complications. While some smaller, slowly growing aneurysms may not cause problems, larger ones are more likely to tear.

When a thoracic aortic aneurysm ruptures, or causes other problems, several serious complications can occur:

• Severe internal bleeding: This is bleeding inside the body. This is a life-threatening emergency. Doctors often need to perform surgery right away to stop the bleeding and save the person's life. The bleeding can come from a tear in the aneurysm.

• Blood clots: The damaged inner lining of the aneurysm can sometimes cause small blood clots to form. If one of these clots breaks free, it can travel to other parts of the body and block blood flow to vital organs like the brain or lungs. This can cause serious problems, or even be deadly.

• Stroke: A blood clot traveling to the brain can cause a stroke. Strokes can cause weakness or paralysis on one side of the body, difficulty speaking, and other serious problems. The symptoms of a stroke can be sudden, and quick medical attention is crucial.

In short, a ruptured or problematic thoracic aortic aneurysm can lead to life-threatening internal bleeding, potentially dangerous blood clots, and even stroke. The size of the aneurysm is a key factor in predicting the risk of these complications.

Maintaining healthy blood vessels is key to preventing an aneurysm, a bulge in a blood vessel. Doctors often suggest these steps to keep your heart and blood vessels strong:

• Quit smoking and using tobacco: Smoking damages blood vessels, making them more prone to problems like aneurysms.
• Get regular exercise: Exercise helps strengthen your heart and blood vessels, reducing your risk of many health problems, including aneurysms.
• Eat a heart-healthy diet: Limit foods high in cholesterol and unhealthy fats. These can build up in your blood vessels, making them less flexible and increasing the risk of an aneurysm.

Sometimes, a family history of certain conditions can increase your risk of a thoracic aortic aneurysm (a bulge in the large blood vessel coming from your heart). If a close relative (like a parent, sibling, child) has a genetic condition like Marfan syndrome, or another condition linked to aneurysms, your doctor might recommend checking for signs of an aneurysm.

This checking process, called screening, often involves regular imaging tests. One common test is an echocardiogram, a type of ultrasound that uses sound waves to create images of your heart and the aorta (the main blood vessel). If the test shows an enlarged aorta or an aneurysm, a follow-up imaging test is typically done in about 6 to 12 months to see if the aneurysm has grown.

If there's a strong family history of aortic aneurysms, especially if you're thinking about getting pregnant, your doctor might recommend genetic testing. This can help determine if you have a genetic predisposition to aneurysms and help you and your doctor plan for any potential risks. This is important, because pregnancy can sometimes put extra stress on the aorta and increase the risk of an aneurysm.

Thoracic aortic aneurysms are often discovered during medical tests for other health issues. If you have symptoms suggesting a thoracic aortic aneurysm, your doctor might ask about your family's health history, as some aneurysms run in families.

Finding and Diagnosing a Thoracic Aortic Aneurysm

Doctors use various imaging tests to confirm or screen for a thoracic aortic aneurysm. These tests can help them see the aorta, the large blood vessel carrying blood from the heart to the rest of the body:

• Echocardiogram: This test uses sound waves to create images of the heart and its blood vessels, including the aorta. A standard echocardiogram might be enough to find an aneurysm. If a clearer view of the aorta is needed, a transesophageal echocardiogram is performed. In this case, a thin, flexible tube with a tiny camera is inserted through your throat and into your esophagus (the tube connecting your mouth to your stomach). This allows for a much closer view of the aorta.

• Computed Tomography (CT) Scan: A CT scan uses X-rays to create detailed cross-sectional images of your body, including your aorta. This helps determine the size and shape of the aneurysm. You'll lie on a table inside a large machine that takes X-rays. Sometimes, a special dye (contrast) is injected into your vein to make the blood vessels, including the aorta, show up more clearly on the images.

• Cardiac Magnetic Resonance Imaging (MRI): An MRI uses strong magnetic fields and radio waves to create detailed images of the heart and aorta. This method helps doctors diagnose an aneurysm and see its size and location. You lie on a table that moves into a tunnel-like machine. Like CT scans, contrast dye might be used to enhance the visibility of the blood vessels. Importantly, MRI does not use radiation. This makes it a good option for people who need frequent imaging tests.

Thoracic Aortic Aneurysm Care at Mayo Clinic

Mayo Clinic's team of experts provide comprehensive care for thoracic aortic aneurysms. They use a variety of imaging tests, including CT scans, to diagnose and manage these conditions. A team of specialists will prepare you for and interpret the results of these tests. They will also address your concerns and help you understand your treatment options. Additional tests and procedures, like genetic testing, may also be considered depending on your specific situation.