What are the signs and symptoms of thoracic aortic aneurysm (TAA)?

Updated: Apr 02, 2021
  • Author: Elaine Tseng, MD; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Patients with TAAs are often asymptomatic. Most patients are hypertensive but remain relatively asymptomatic until the aneurysm expands. Their most common presenting symptom is pain. Pain may be acute, implying impending rupture or dissection, or chronic, from compression or distention. The location of pain may indicate the area of aortic involvement, but this is not always the case. Ascending aortic aneurysms tend to cause anterior chest pain, whereas arch aneurysms more likely cause pain radiating to the neck. Descending thoracic aneurysms more likely cause back pain localized between the scapulae. When located at the level of the diaphragmatic hiatus, the pain occurs in the mid back and epigastric region.

Large ascending aortic aneurysms may cause superior vena cava obstruction manifesting as distended neck veins. Ascending aortic aneurysms also may develop aortic insufficiency, with widened pulse pressure or a diastolic murmur, and heart failure. Arch aneurysms may cause hoarseness, which results from stretching of the recurrent laryngeal nerves. Descending thoracic aneurysms and thoracoabdominal aneurysms may compress the trachea or bronchus and cause dyspnea, stridor, wheezing, or cough. Compression of the esophagus results in dysphagia.

Erosion into surrounding structures may result in hemoptysis, hematemesis, or GI bleeding. Erosion into the spine may cause back pain or instability. Spinal cord compression or thrombosis of spinal arteries may result in neurologic symptoms of paraparesis or paraplegia. Descending thoracic aneurysms may thrombose or embolize clot and atheromatous debris distally to visceral, renal, or lower extremities.

Patients who present with ecchymoses and petechiae may be particularly challenging because these signs probably indicate disseminated intravascular coagulation (DIC). The risk of significant perioperative bleeding is extremely high, and large amounts of blood and blood products must be available for resuscitative transfusion.

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