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An aortic aneurysm is the bulging of a portion of the aortic wall. Aortic aneurysms are
believed to be caused by the gradual weakening of the artery due to atherosclerosis,
arterial narrowing and hardening from cholesterol plaque build-up. Other causes include
hypertension (high blood pressure), Marfan syndrome (genetic connective tissue disease),
infectious diseases such as syphilis or tuberculosis, or possibly a genetic predisposition
in the case of abdominal aortic aneurysm.
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Overview and Symptoms of Aortic Aneurysm
Abdominal aneurysms are most common form of aortic aneurysm, comprising 75% of cases.
Abdominal aneurysms are most often seen in men aged 40 to 70. Patients may also suffer
thoracic aneurysms (in the chest cavity). Aortic aneurysms may be further classified as
either fusiform (the aneurysm bulges in equal proportions and tapers at the ends, often
seen in the lower abnormal aortic section) or saccular (the aneurysm bulges in only a
portion of the aortic wall, often seen above the heart).
The rupturing of an aortic aneurysm is a life-threatening condition that requires
immediate attention to prevent considerable internal bleeding, which may result in death.
The risk of rupture is high if the abdominal aneurysm is more than four centimeters or the
thoracic aneurysm is less than six centimeters. Another condition, an aortic dissection,
occurs when a portion of the aortic lining tears. Aortic dissection accompanies aortic
aneurysm in some cases. The risk of rupture from aortic dissection is more substantial
than from aortic aneurysm.
Aortic aneurysm may or may not be accompanied by symptoms, including:
- Swelling or pain in the abdomen or lower back; may be severe if the aneurysm has
ruptured (with abdominal aneurysm)
- Neck or back pain (with thoracic aneurysm)
- Cough, hoarseness or difficulty swallowing (with thoracic aneurysm)
- Chest pain (with thoracic aneurysm, may be mistaken for myocardial infarction)
- Swelling of neck or arms (with thoracic aneurysm)
- Dramatic decrease in blood pressure
- Nausea or blurred vision
Diagnosing Aortic Aneurysm
Diagnosing an aortic aneurysm typically begins with a physical examination and blood
pressure test. Careful documentation of family and medical history should also be noted at
this time. Additional exams to test or confirm aortic aneurysm include:
- Echocardiogram (heart ultrasound): This diagnostic technique is an excellent
tool to provide details of the cardiac structures – vessels, valves, and muscle.
Echocardiography is a non-invasive exam in which images are acquired and viewed in real
time without the use of radiation. Echocardiography is often useful in studying the
beating heart and provides some information on functional abnormalities of the heart wall,
valves and blood vessels. Echocardiography with Doppler is used to measure blood flow
across valves, across septal defects (shunts), extent of regurgitations, etc. Color flow
mapping capability is extremely useful in the detection of shunts. Abnormal operation of
the valves can be detected by studying the opening and closing function versus normal
valve function. Echocardiography may also be used to study congenital heart defects such
as a septal defect (a hole in the wall that separates the two chambers of the heart).
- Chest x-ray: A chest x-ray images the heart and
surrounding thoracic anatomy, shows heart size and shape, and reveals whether the heart is
misshapen or enlarged due to disease. Abnormal calcification (hardened blockage due to
cholesterol build up) in the main blood vessels and fluid in the lungs (possible
indication of congestive heart failure) can also be seen. Chest x-rays can also be used to
image pacemakers and artificial heart valves to check for correct positioning.
- Cardiac magnetic resonance (MR): Magnetic resonance
(MR) imaging of the heart is a unique application that can provide valuable information in
certain situations. Cardiac MR provides non-invasive imaging of the heart. Ultra-fast 2D
and 3D imaging techniques coupled with the latest MR hardware now allow improved diagnosis
in as little as a single breath-hold. New techniques are also being developed which allow
first pass perfusion imaging of the heart. Cardiac MR applications and techniques are
continuously improving and their use varies from center to center. However, cardiac MR
applications appear to be very promising and may provide an excellent means to diagnose a
number of heart conditions without requiring the use of x-rays or contrast injection, as
with conventional x-ray angiography.
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| Sagittal multiplanar reconstructed CT image of the thorax and abdomen showing
an aortic aneurysm. The aorta (short arrow) looks like a white "candy-cane" in
the middle of this image. The aneurysm (long arrow) is the thin line running through the
candy cane. |
- Fast/multi-slice CT scan: Fast/multi-slice spiral CT
scan with ECG gating is a new non-invasive method of imaging the heart and coronary
arteries. In some cases, ECG gated fast/multi-slice CT eliminates the need for
conventional cardiac angiography which requires invasive catheterization. Fast/multi-slice
CT is particularly useful in that it can show calcium deposits in the coronaries that form
with plaque-build up and may eventually lead to myocardial
infarction (heart attack). Early imaging of stenoses (narrowing or arteries) and
calcium deposits in the coronary arteries can allow aggressive preventive measures or
treatment to be implemented, thus lowering the risk of myocardial infarction.
CONTINUED
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