cardiovascular disorders
Thoracic Aortic Aneurysms
Symptoms and Signs of Thoracic Aortic Aneurysms
Most thoracic abdominal aneurysms are asymptomatic until complications (eg, thromboembolism, rupture, aortic regurgitation, dissection) develop. However, compression of adjacent structures can cause back pain (due to compression of vertebra), cough or wheezing (due to compression of the tracheobronchial tree), dysphagia (due to esophageal compression), hoarseness (due to left recurrent laryngeal or vagus nerve compression), chest pain (due to coronary artery compression), and Regional spread (due to compression of the central veins or superior vena cava). Erosionof aneurysms into the lungs causes hemoptysis or pneumonitis; erosion into the esophagus (aortoesophageal fistula) causes massive hematemesis. Dissectionmanifests with tearing chest pain, often radiating to the back between the shoulder blades. Thromboembolismmay cause stroke, abdominal pain (due to mesenteric ischemia), or extremity pain. Ruptured TAAthat is not immediately fatal manifests with severe chest or back pain and hypotension or shock. Exsanguination due to rupture most commonly occurs into the pleural or pericardial space. Additional signs include Horner Syndrome (miosis, ptosis, anhidrosis) due to compression of sympathetic ganglia, palpable downward pull of the trachea with each cardiac contraction (tracheal tug), and tracheal deviation. Visible or palpable chest wall pulsations, occasionally more prominent than the left ventricular apical impulse, are unusual but may occur. Syphilitic aneurysms of the aortic root classically lead to Aortic Regurgitation and inflammatory stenosis of the coronary artery ostia, which may manifest as chest pain due to myocardial ischemia. Syphilitic aneurysms do not dissect. 