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19th February, 20214 min read

Thoracic aortic aneurysm and dissection

Medical reviewer: Dr Ann Nainan
Author: Dr Lauretta Ihonor
Last reviewed: 07/02/2021
Medically reviewed

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What is a thoracic aortic aneurysm and dissection?

A thoracic aortic aneurysm is when a section of the upper part of your aorta – the main blood vessel that carries blood from your heart – becomes weak and bulges out.

It’s a serious condition because the aneurysm can tear or burst. This is known as a thoracic aortic dissection and it can cause a lot of internal bleeding, which can lead to death.

Symptoms of thoracic aortic aneurysm

A thoracic aortic aneurysm usually doesn’t cause symptoms unless it bursts (ruptures) or the lining of the aorta starts to tear and leak.

But it can sometimes cause symptoms, especially if it gets really big or starts to push on surrounding parts of your body.

The symptoms of a thoracic aortic aneurysm include:

  • chest, jaw, neck, back or upper tummy pain
  • coughing
  • wheezing
  • difficulty breathing
  • shortness of breath
  • hoarseness
  • difficulty swallowing or pain when swallowing

If the aneurysm tears or bursts, you may get a really bad sharp pain in your chest or back that may feel like you’re having a heart attack.

This can happen without warning, so if you suddenly develop really bad chest or back pain, or you notice any of the other symptoms listed above, go to the emergency department or call an ambulance immediately.

What causes a thoracic aortic aneurysm?

It’s not clear why some people get thoracic aortic aneurysms, but certain factors can raise your risk of the condition.

These include:

  • smoking
  • being male
  • having family members who have had a thoracic aortic aneurysm
  • having high blood pressure or high cholesterol
  • having an aneurysm in the lower part of your aorta
  • having certain genetic conditions, including Marfan’s syndrome and other connective tissue disorders
  • having a problem with the heart valve that lets blood into your aorta
  • ongoing lung and kidney disease

How is a thoracic aortic aneurysm diagnosed?

Because thoracic aortic aneurysms usually don’t cause symptoms if they aren’t torn, they’re usually discovered by accident – often during tests for something else.

If a doctor thinks you have a thoracic aortic aneurysm, they’ll usually do imaging tests, like a CT or MRI scan, to make sure.

You may also be given:

  • blood tests – to check for infections or inflammation that may be involved
  • echocardiogram – an ultrasound scan of your heart and aorta

How is a thoracic aortic aneurysm treated?

If you have a torn or burst aortic aneurysm, you’ll need emergency surgery to fix it. This may be keyhole surgery or an open procedure.

If the aneurysm hasn’t burst, the treatment you’ll usually receive for a thoracic aortic aneurysm will depend on how large it is and the symptoms you’re having.

For small aneurysms (less than 5.5 cm) that aren’t causing symptoms, a doctor will usually do nothing other than monitor you. This usually involves having regular checkups and scans every 3 months to a year.

You’ll usually also be advised to make lifestyle changes to reduce your risk of the aneurysm getting bigger or bursting.

These lifestyle changes may include:

  • losing weight if you’re overweight or obese
  • exercising regularly – but stick to gentle exercise to avoid putting excess strain on your aorta (a doctor can advise you on the safest exercises to do)
  • not smoking
  • eating a healthy, balanced diet – a doctor or nutritionist can advise you on what a healthy diet looks like for you

You may also need to take medication to treat high blood pressure and high cholesterol.

You’ll also need to have treatment for any health condition you have that may be causing your aneurysm.

When will I need surgery?

While close monitoring and lifestyle changes are all that’s needed in some cases, other aneurysms need surgery. You’ll usually need surgery to treat a thoracic aortic aneurysm if:

  • the aneurysm starts to leak or bursts open
  • the aneurysm isn’t leaking, but it’s:
    • larger than 5.5cm
    • growing quickly
    • causing symptoms like chest pain and difficulty breathing

A doctor may also recommend surgery if you have risk factors that mean the aneurysm is more likely to burst.

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