Thoracic aortic aneurysm history and symptoms: Difference between revisions

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{{Template:Thoracic aortic aneurysm}}
{{Template:Thoracic aortic aneurysm}}
{{CMG}} {{AE}}  [[User:Mohammad Salih|Mohammad Salih, MD.]]


{{CMG}}
==Overview==
Most thoracic aortic aneurysms are asymptomatic and diagnosed incidentally on imaging studies.  The development of symptoms can indicate that the thoracic aortic aneurysm is expanding.  When symptoms are present, they are generally due to compression of adjacent structures.  These compressive symptoms include [[dysphagia]] (compression of the [[esophagus]]), [[dyspnea]] and chronic [[cough]] (compression of the airway), or [[hoarseness]] (compression of the [[recurrent laryngeal nerve]]).


'''Editor-in-Chief:''' Amjad AlMahameed, MD, MPH, RPVI, FACP. Beth Israel Deaconess Medical Center and Harvard Medical School. Boston, USA
==History and Symptoms==
====Ascending Aorta Aneurysm====
*May cause anterior [[chest pain]] and symptoms of [[superior vena cava obstruction]] ([[swollen face]], neck, upper body, and arms).


==Diagnosis==
====Thoracic Aortic Arch Aneurysm====
Most TAAs are asymptomatic and diagnosed incidentally on imaging studies. Common clues to the possibility of TAA include widening of the mediastinum on chest X-ray, dilated aortic root on [[transthoracic echocardiography]], and enlarged ascending aorta or aortic arch by [[transesophageal echocardiography]].  
*May cause [[neck pain]] and [[hoarseness]] due to stretching of the recurrent laryngeal nerves.


[[CT angiography]] is the imaging modality of choice for TAAs but [[MRA]] is also an excellent test. Once diagnosd, serial [[CTA]] (or [[MRA]]) are recommended every 6-12 months based on the initial aneurysm size, its etiology (Marfan's vs not), type (dissecting vs not), and patient's health status (pregnant vs not).
====Descending Aorta Thoracic Aneurysm====
 
*May cause [[back pain]] between the scapulae.
When symptomatic, patients presents with complaints related to compression of adjacent  structures. These include [[dysphagia]] (compression of the esophygus), [[dyspnea]] and chronic [[cough]] (airway), or [[hoarseness]] (recurrent laryngeal nerve).
*May increase pressure to the [[trachea]] or [[bronchus]], consequently causing [[dyspnea]], [[stridor]], [[wheezing]], or [[cough]].
 
 
Images shown below are courtesy of RadsWiki and copylefted.
 
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==ACC/ AHA Guidelines - Recommendations for History and Physical Examination for Thoracic aortic disease (DO NOT EDIT)==


==2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (DO NOT EDIT)<ref name="pmid20233780">{{cite journal| author=Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE et al.| title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. | journal=Circulation | year= 2010 | volume= 121 | issue= 13 | pages= e266-369 | pmid=20233780 | doi=10.1161/CIR.0b013e3181d4739e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20233780  }} </ref>==
===History and Physical Examination for Thoracic Aortic Disease (DO NOT EDIT)<ref name="pmid20233780">{{cite journal| author=Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE et al.| title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. | journal=Circulation | year= 2010 | volume= 121 | issue= 13 | pages= e266-369 | pmid=20233780 | doi=10.1161/CIR.0b013e3181d4739e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20233780  }} </ref>===
{|class="wikitable"
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
|bgcolor="LightGreen" | '''1.''' For patients presenting with a history of acute cardiac and noncardiac symptoms associated with a significant likelihood of thoracic aortic disease, the clinician should perform a focused physical examination, including a careful and complete search for arterial perfusion differentials in both upper and lower extremities, evidence of visceral ischemia, focal neurological deficits, a murmur of aortic regurgitation, bruits, and findings compatible with possible cardiac tamponade ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
|bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' For patients presenting with a history of acute cardiac and noncardiac symptoms associated with a significant likelihood of thoracic aortic disease, the clinician should perform a focused physical examination, including a careful and complete search for arterial perfusion differentials in both upper and lower extremities, evidence of visceral ischemia, focal neurological deficits, a [[murmur]] of [[aortic regurgitation]], [[bruit]]s, and findings compatible with possible [[cardiac tamponade]].<ref>Townsend CM, Beauchamp RD, Evers BM, et al. Sabiston Textbook of Surgery. 18th ed. Philadelphia: Elsevier Health Sciences, 2008.</ref><ref>Libby P, Bonow RO, Mann DL, et al. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia: 2007.</ref><ref>Isselbacher E. Cecil Medicine. 23rd ed. Philadelphia: Elsevier Health Sciences, 2008.</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}


==References==  
==References==  
 
{{reflist|2}}
[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Vascular surgery]]
[[Category:Vascular surgery]]

Latest revision as of 21:08, 22 January 2020

Thoracic aortic aneurysm Microchapters

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Overview

Historical Perspective

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Pathophysiology

Causes

Differentiating Thoracic Aortic Aneurysm from other Diseases

Epidemiology and Demographics

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Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

General Approach to Imaging in Thoracic Aortic Aneurysm

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohammad Salih, MD.

Overview

Most thoracic aortic aneurysms are asymptomatic and diagnosed incidentally on imaging studies. The development of symptoms can indicate that the thoracic aortic aneurysm is expanding. When symptoms are present, they are generally due to compression of adjacent structures. These compressive symptoms include dysphagia (compression of the esophagus), dyspnea and chronic cough (compression of the airway), or hoarseness (compression of the recurrent laryngeal nerve).

History and Symptoms

Ascending Aorta Aneurysm

Thoracic Aortic Arch Aneurysm

Descending Aorta Thoracic Aneurysm

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (DO NOT EDIT)[1]

History and Physical Examination for Thoracic Aortic Disease (DO NOT EDIT)[1]

Class I
"1. For patients presenting with a history of acute cardiac and noncardiac symptoms associated with a significant likelihood of thoracic aortic disease, the clinician should perform a focused physical examination, including a careful and complete search for arterial perfusion differentials in both upper and lower extremities, evidence of visceral ischemia, focal neurological deficits, a murmur of aortic regurgitation, bruits, and findings compatible with possible cardiac tamponade.[2][3][4] (Level of Evidence: C)"

References

  1. ↑ 1.0 1.1 Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE; et al. (2010). "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine". Circulation. 121 (13): e266–369. doi:10.1161/CIR.0b013e3181d4739e. PMID 20233780.
  2. ↑ Townsend CM, Beauchamp RD, Evers BM, et al. Sabiston Textbook of Surgery. 18th ed. Philadelphia: Elsevier Health Sciences, 2008.
  3. ↑ Libby P, Bonow RO, Mann DL, et al. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia: 2007.
  4. ↑ Isselbacher E. Cecil Medicine. 23rd ed. Philadelphia: Elsevier Health Sciences, 2008.

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