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2、acic Aorta Aneurysm Presented by :Shamaa suliman Anatomy of the thoracic aorta ?Divided to: the aortic root, the ascending aorta, the aortic arch, and the descending thoracic aorta. ?Aortic root: is a short segment of the aorta arising from the base of the heart, containing the valve, the right and
3、left coronary arteries (3.6cm) ?The ascending aorta extends from the root to the origin of the right brachiocephalic artery. (3.5cm) ?The aortic arch begins at the origin of the right brachiocephalic artery and ends at the attachment of the ligamentum arteriosum, gives left subclavian artery, also g
4、iving rise to the left common carotid artery ?The descending thoracic aorta begins after the ligamentum arteriosum and extends to the aortic hiatus in the diaphragm T12 (2.5cm) Pathologies Affecting The Thoracic Aorta Thoracic Aortic Aneurysms. Aortic Dissection. Thoracic Aortic Aneurysms Definition
5、 ?TAA is a life-threatening condition that causes significant short- and long-term mortality due to rupture and dissection. Aneurysm is defined as dilatation of the aorta with a diameter at least 50% greater than the normal size of the artery. ? For the thoracic aorta a diameter greater than 4.5cm c
6、ould be considered aneurysmal. ?Prevalence of aortic aneurysms probably exceeds 3-4% in individuals older than 65 years. The incidence of thoracic aortic rupture of 3.5 per 100,000 persons Thoracic Aortic Aneurysms True aneurysm: is a localized dilatation of a blood vessel involving all layers of th
7、e vessel (intima, media and adventia). False aneurysm having a single layer of fibrous tissue as the wall of the sac which is the adventia ( this could result from trauma, dissection or previous surgery). Whereas, an aortic dissection is formed by an intimal tear and is contained by the media. Thora
8、cic Aortic Aneurysms Thoracic Aneurysms are described as: Fusiform when the whole circumference is affected (ture) Saccular when only part of the circumference is involved. (false) Thoracic Aortic Aneurysms Aortic aneurysms: thoracic aortic aneurysms, including those that extend into the upper abdom
9、en (thoracoabdominal aneurysms), account for 25%. Abdominal aortic aneurysm account for 75% ?TAA typically occurring in men in the 5th to 7th decade or younger in those with connective tissue disorders 1)Arteriosclerotic is the most common cause of thoracic aneurysms 2) Connective tissue disorders:
10、Marfans Syndrome: is associated with cystic medial degeneration involving the vessel wall and causes widening of the proximal aorta and aortic root, leading to aortic valve insufficiency. Ehlers-Danlos Syndrome: results in a deficiency in the production of type III collagen Osteogenesis imperfecta:
11、deficiency of type-I collagen Aetiology 3) Trauma: typically following blunt chest injury, can lead to aneurysm formation, usually false aneurysms containing hematoma from injury to the aortic vessel wall (eg motor vehicle accident) 4) infection (bacterial, mycotic or syphilitic) 5) Arteritis (giant
12、 cell, Takayasu, Kawasaki, Beh&amp;amp;amp;amp;amp;amp;#231;et) Aetiology Risk factors: Male Older age Smoking. HTN. High cholesterol levels Obesity. Family history Chronic obstructive pulmonary disease Clinical Features Most aneurysms are asymptomatic and discovered incidentally on routine
13、chest radiograph. The most common symptom is pain due to pressure exerted by the aneurysm on adjacent structures Ascending aortic aneurysms tend to cause anterior chest pain, while arch aneurysms more likely cause pain radiating to the neck. Descending thoracic aneurysms more likely cause back pain
14、localized between the scapulae. When located at the level of the diaphragmatic hiatus, the pain occurs in the mid back and epigastric region Clinical Features ?Other symptoms are hoarseness (recurrent laryngeal nerve), dysphagia (oesophagus), respiratory symptoms (left main bronchus) or neurological
15、 symptoms. ?Patient with ascending aortic aneurysms also may develop aortic insufficiency, with widened pulse pressure or a diastolic murmur, and heart failure Clinical Features Rupture can lead to cardiac tamponade or hemorrhage into the left pleural space, leading to dyspnoea. 30 % of patients wit
16、h thoracic aortic aneurysms have aneurysms of the aorta at a different site ( rule out AAA ). Investigations The diagnosis is confirmed by CT or MRI, which will often show the extent of the aneurysm. Arteriography is not necessary for diagnosis but is often required to demonstrate the relation of th
17、e arch vessels to the aneurysm. CT ?Aortic aneurysm rupture. aortic arch reveals an aortic aneurysm with contrast penetrating the thrombus within the aneurysm ?Atherosclerotic vascular dis-ease in an aortic aneurysm Aneurysm of proximal descending thoracic aorta on X- ray chest PA view Indications f
18、or Surgery Without treatment the aneurysm is likely to expand and ultimately rupture so surgical treatment is advised. ?Important factors taken into consideration when planning treatment: ?1- age. ?2- general condition of the pat&amp;amp;amp;amp;amp;lt;/p&amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;lt;/p&amp;amp;amp;amp;gt;&amp;amp;amp;lt;/p&amp;amp;amp;gt;&amp;amp;lt;/p&amp;amp;gt;&amp;lt;/p&amp;gt;&lt;/p&gt;</p></p>
