Ascending aortic aneurysm

Changed by Henry Knipe, 28 Jun 2016

Updates to Article Attributes

Body was changed:

Show markup changes

Ascending aortic aneurysms are the most common subtype of thoracic aortic aneurysms, and may be true or false injuries. Aneurysmal dilatation is considered ~~with~~when the ascending aorta measures >4.0 cm in diameter.

Epidemiology

Ascending aortic aneurysms represent 60% of thoracic aortic aneurysms.

Clinical presentation

Typically ascending aortic aneurysms are an incidental finding and the patient is asymptomatic. Rarely, the patient may present with symptoms and signs of rupture (e.g. pain, hypotension).

Pathology

Ascending aortic aneurysms are defined as permanent dilatation of the ascending aorta >4 cm.

Aetiology

True aneurysms can result from a wide variety of conditions:

False aneurysms are seen in the setting of trauma, particularly deceleration injuries, as well as potentially post thoracic aortic surgery.

Radiographic features

Plain radiograph

Ascending aortic aneurysms may manifest as a widening of the aortic or mediastinal silhouettes. The ascending aorta usually does not form part of the right cardiomediastinal margin in the first five decades. If it does, suspect dilatation or aneurysm formation.

CT/MRI

ECG-gating results in superior image quality and pulsation artifacts often result in over-estimation of the ascending aortic diameter ⁵.

Diameter of the ascending aorta should be measured at multiple levels, making follow-up scans more accurate for comparison ^4,5:

level of the aortic annulus
level of the aortic sinus
level of sinotubular junction
mid ascending aorta
high ascending aorta (just inferior to brachiocephalic trunk)
aortic arch
descending aorta

MRI may be preferred over CT for long-term follow-up, especially in younger patients in view of minimising radiation exposure.

Treatment and prognosis

As with other aortic aneurysms, increasing size results in an increasing risk of rupture with the risk of rupture of ~7% per year in patients with an aneurysm >6.0 cm ⁵.

Treatment is advocated in patients with an aneurysm >5.0 cm or 5.5 cm in diameter or increasing at >0.5 cm per year. Smaller aneurysmal diameter (>4.5 cm) is accepted in patients undergoing aortic valve replacement ⁴.

Differential diagnosis

aortic dissection

-<p><strong>Ascending aortic aneurysms</strong> are the most common subtype of thoracic aortic aneurysms, and may be true or false injuries. Aneurysmal dilatation is considered with the ascending aorta measures >4.0 cm in diameter. </p><h4>Epidemiology</h4><p>Ascending aortic aneurysms represent 60% of <a href="/articles/thoracic-aortic-aneurysms">thoracic aortic aneurysms</a>. </p><h4>Clinical presentation</h4><p>Typically ascending aortic aneurysms are an incidental finding and the patient is asymptomatic. Rarely, the patient may present with symptoms and signs of rupture (e.g. pain, hypotension). </p><h4>Pathology</h4><p>Ascending aortic aneurysms are defined as permanent dilatation of the <a href="/articles/ascending-aorta">ascending aorta</a> >4 cm.</p><h5>Aetiology</h5><p><a href="/articles/true-aneurysm">True aneurysms</a> can result from a wide variety of conditions:</p><ul>
+<p><strong>Ascending aortic aneurysms</strong> are the most common subtype of thoracic aortic aneurysms, and may be true or false injuries. Aneurysmal dilatation is considered when the ascending aorta measures >4.0 cm in diameter. </p><h4>Epidemiology</h4><p>Ascending aortic aneurysms represent 60% of <a href="/articles/thoracic-aortic-aneurysms">thoracic aortic aneurysms</a>. </p><h4>Clinical presentation</h4><p>Typically ascending aortic aneurysms are an incidental finding and the patient is asymptomatic. Rarely, the patient may present with symptoms and signs of rupture (e.g. pain, hypotension). </p><h4>Pathology</h4><p>Ascending aortic aneurysms are defined as permanent dilatation of the <a href="/articles/ascending-aorta">ascending aorta</a> >4 cm.</p><h5>Aetiology</h5><p><a href="/articles/true-aneurysm">True aneurysms</a> can result from a wide variety of conditions:</p><ul>

ADVERTISEMENT: Supporters see fewer/no ads

{"current_user":null,"inclusions":[{"imageId":1394462,"studyId":14990,"caseSlug":"ascending-aortic-aneurysm","caption":"Case 1: true aneurysm","thumbnail":"https://prod-images-static.radiopaedia.org/images/1394462/4859b4925995784785931451fc6c3e_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":2752449,"studyId":20846,"caseSlug":"ascending-aortic-aneurysm-2","caption":"Case 2","thumbnail":"https://prod-images-static.radiopaedia.org/images/2752449/5a50ce4e74bf80df6972d45fa1be11_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":51633851,"studyId":81828,"caseSlug":"ascending-aortic-aneurysm-3","caption":"Case 3: ascending aortic aneurysm ","thumbnail":"https://prod-images-static.radiopaedia.org/images/51633851/249e85fed137c7a7fbfb189947539d_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":51718739,"studyId":82599,"caseSlug":"massive-aortic-aneurysm-dissection-and-pericardial-effusion","caption":"Case 4","thumbnail":"https://prod-images-static.radiopaedia.org/images/51718739/7afbd1d8c6732abe7f742fc061db9e_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52424387,"studyId":88034,"caseSlug":"aortic-root-aneurysm","caption":"Case 5","thumbnail":"https://prod-images-static.radiopaedia.org/images/52424387/5bf2fbd0c497c88d477c06fe1901b6_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":5803268,"studyId":27639,"caseSlug":"ascending-aortic-aneurysm-4","caption":"Case 6","thumbnail":"https://prod-images-static.radiopaedia.org/images/5803268/140ce252b4222d1d3f18b34c4acf59_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"}],"ddx_inclusions":[{"imageId":956,"studyId":9663,"caseSlug":"aortic-dissection-stanford-a-3","caption":"Aortic dissection","thumbnail":"https://prod-images-static.radiopaedia.org/images/956/eb73e64f7550922c98bd517453b6ab_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"}],"lang":"us"}