Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ KEY FEATURES ++ ESSENTIALS OF DIAGNOSIS ++ Ascending aortic diameter > 4 cm on imaging study Descending aortic diameter > 3.5 cm on imaging study ++ GENERAL CONSIDERATIONS ++ Ascending aortic aneurysms usually fall into 1 of 3 patterns: Supracoronary sinus dilatation Annuloaortic ectasia (Marfan’s syndrome) Diffuse tubular enlargement Descending aortic aneurysm are classified into 4 types (Crawford classification): Thoracic and upper abdominal aorta Entire thoracic and abdominal aorta Lower thoracic and abdominal Predominantly abdominal Aortic aneurysms are often familial (eg, Marfan’s syndrome) Aortic aneurysms grow about 1 mm/year and grow faster in the descending aorta compared with the ascending aorta As the aorta enlarges, rupture becomes more likely in an exponential fashion with the rapid acceleration point of the curve at 6 cm for the ascending aorta and 7 cm for the descending aorta ++ CLINICAL PRESENTATION ++ SYMPTOMS AND SIGNS ++ Generally no symptoms until rupture or dissection occurs Deep visceral pain in upper anterior chest or back Possible dysphagia or stridor ++ PHYSICAL EXAM FINDINGS ++ Possible aortic regurgitation murmur Signs of Marfan’s syndrome Rarely, anterior upper chest wall pulsations ++ DIFFERENTIAL DIAGNOSIS ++ Aortic dissection Aortic rupture with contained hematoma Mediastinal or thoracic tumor ++ DIAGNOSTIC EVALUATION ++ IMAGING STUDIES ++ Chest x-ray: thoracic aortic aneurysms are almost always visible CT or MRI: defines the aortic anatomy very well ++ DIAGNOSTIC PROCEDURES ++ Aortography is rarely used today ++ TREATMENT ++ CARDIOLOGY REFERRAL ++ Significant aortic regurgitation Suspected cardiac disease ++ HOSPITALIZATION CRITERIA ++ Pain likely from aneurysm Planned surgery ++ THERAPEUTIC PROCEDURES ++ Endoluminal stent grafts are an alternative in selected cases ++ SURGERY ++ Surgical replacement with a synthetic graft is considered in asymptomatic patients at the following diameters: Table Graphic Jump LocationFavorite Table | Download (.pdf) | Print Non-Marfan’s Marfan’s Ascending 5.0 cm 5.5 cm Descending 6.0 cm 6.5 cm Symptomatic aneurysms (pain, impingement on other structures) need immediate replacement ++ MONITORING ++ ECG monitoring in hospital as appropriate ++ DIET AND ACTIVITY ++ Restricted activity in symptomatic patients until surgery is completed Asymptomatic patients should not do major weight lifting ++ ONGOING MANAGEMENT ++ HOSPITAL DISCHARGE CRITERIA ++ Resolution of problem Successful surgery ++ FOLLOW-UP ++ Stable, asymptomatic patients should have repeat imaging every 2 years New patients with moderately large aneurysms should be imaged in 3–6 months; if stable in 1 year, then every 2 years ++ COMPLICATIONS ++ Dissection Rupture ++ PROGNOSIS... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. What is MyAccess? Create a FREE MyAccess profile to: Use this site remotely Bookmark your favorite content Track your self-assessment progress and more! GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessCardiology 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessCardiology Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options