Descending Thoracic Aortic Aneurysm
Descending thoracic aortic aneurysms are the third most common type of aortic aneurysm. The majority of patients are diagnosed in their 6th and 7th decade of life. Most patients are without symptoms for a long period of time until the thoracic aortic aneurysm is very advanced or found incidentally on a chest x-ray (see below) CT scan or MRI.
The descending thoracic aorta is located in the posterior thorax (back part of your chest cavity). As the aortic arch curves from the front portion of the thorax towards the back the descending thoracic aorta continues down the posterior portion of the chest cavity (see anatomy section). The anatomical boundaries of the descending thoracic aorta are the left subclavian artery and the celiac artery (this is the first major artery in the abdominal cavity). The location of the descending aorta provides some idea about the symptoms one may experience if there is a problem with this portion of the thoracic aorta.
The descending thoracic aorta is located in the posterior thorax (back part of your chest cavity). As the aortic arch curves from the front portion of the thorax towards the back the descending thoracic aorta continues down the posterior portion of the chest cavity (see anatomy section). The anatomical boundaries of the descending thoracic aorta are the left subclavian artery and the celiac artery (this is the first major artery in the abdominal cavity). The location of the descending aorta provides some idea about the symptoms one may experience if there is a problem with this portion of the thoracic aorta.
PRESENTATION
CT scan: descending thoracic aneurysm
Common causes of aortic aneurysms of the descending aorta included atherosclerosis, aortic dissection, penetrating ulcer, infection, and connective tissue disorders. Theses aortic diseases are discussed in further detail in their respective section.
The presentation for the majority of descending aortic diseases is back pain or vague chest pain. Other symptoms include difficulty swallowing, hoarseness, and difficulty breathing (compression on the lung airway) and cough.
The plain chest x-ray is not a common diagnostic tool to indentify problems with the descending thoracic aorta however, it is a study that commonly discovers these aneurysms accidentally. The chest x-ray may show that the heart shadow is widened and an exaggeration of the aortic contour (see above). The gold standard test to diagnosis descending thoracic aortic problems has become the CT scan angiogram and MR angiogram. A transesophageal echocardiogram can provide the approximate size of the aorta and the presence of a dissection. and other abnormalities.
A majority of descending thoracic aortic diseases can be treated conservatively. When we speak of conservative management this refers to blood pressure control, smoking cessation, cholesterol control, aerobic exercise, and avoiding heavy weight lifting. However, symptoms related to a descending aortic aneurysm or dissection should be taken seriously:
The gold standard for repair of descending aortic aneurysms is open surgical repair. However, certain diseases of the descending thoracic aorta lend themselves to endovascular therapies. In addition, patients who are old and frail and with many medical problems, specifically, severe heart and lung problems will do better with endovascular stenting (TEVAR) of the descending aorta. However, many factors are considered prior to making any recommendations for either approach.
The presentation for the majority of descending aortic diseases is back pain or vague chest pain. Other symptoms include difficulty swallowing, hoarseness, and difficulty breathing (compression on the lung airway) and cough.
The plain chest x-ray is not a common diagnostic tool to indentify problems with the descending thoracic aorta however, it is a study that commonly discovers these aneurysms accidentally. The chest x-ray may show that the heart shadow is widened and an exaggeration of the aortic contour (see above). The gold standard test to diagnosis descending thoracic aortic problems has become the CT scan angiogram and MR angiogram. A transesophageal echocardiogram can provide the approximate size of the aorta and the presence of a dissection. and other abnormalities.
A majority of descending thoracic aortic diseases can be treated conservatively. When we speak of conservative management this refers to blood pressure control, smoking cessation, cholesterol control, aerobic exercise, and avoiding heavy weight lifting. However, symptoms related to a descending aortic aneurysm or dissection should be taken seriously:
- back pain
- chest pain
- change in voice character
- shortness of breath
- coughing up bloody mucus/secretions
The gold standard for repair of descending aortic aneurysms is open surgical repair. However, certain diseases of the descending thoracic aorta lend themselves to endovascular therapies. In addition, patients who are old and frail and with many medical problems, specifically, severe heart and lung problems will do better with endovascular stenting (TEVAR) of the descending aorta. However, many factors are considered prior to making any recommendations for either approach.
