Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

1420 Thoracic Aortic Aneurysm

tests

■Specific diagnostic tests: chest x-ray

➣Usually apparent on standard PA and lateral films, however small

saccular aneurysms may not be seen and are still prone to rupture

■Other imaging tests

➣CT and TEE good, comparable for defining thoracic aneurysm

➣MRI/MRA usually offers even better anatomic definition, may

replace angiography

➣Angiography remains gold standard for many or most surgeons

differential diagnosis

■Peri-aortic thoracic mass

management

What to Do First

■Assess risk of rupture, treat hypertension if present

General Measures

■Determine size (>6 cm indicates surgery)

specific therapy

Indication for surgical therapy: aneurysm >6 cm

Treatment Options

■Surgical repair, generally with Dacron prosthesis.

Side Effects & Contraindications

■Side effects: major hemorrhage, spinal cord injury (>−5%), death

(∼6–9%), CVA/MI/renal failure mainly related to patients with

atherosclerotic etiology

■Contraindications: Absolute: severe pulmonary disease, contraindi-

cations to systemic anticoagulation

follow-up

■If aneurysm <5 cm, follow with imaging every 6–12 months, treat

hypertension if present

complications and prognosis

■Complications: see side effects

■Prognosis: 5 year survival∼66% with surgery; 27% if symptomatic or

58% if asymptomatic and medically managed