Synopsis
Recognize thoracic aortic aneurysm, measure each segment correctly, identify genetic risk, and time specialist surveillance or repair.
- Thoracic aneurysm risk depends on segment, maximal orthogonal diameter, growth, symptoms, morphology, valve anatomy, genetic cause, body size and operative fitness.
- Sudden severe chest or back pain, collapse, neurological deficit or new aortic regurgitation demands an acute aortic syndrome pathway rather than outpatient surveillance.
- Image the entire aorta at diagnosis and assess the aortic valve; tandem aneurysms and extension across conventional segment labels are common.
Key red flags
New abrupt chest or interscapular pain, syncope, hypotension or haemothorax suggests rupture or dissection and requires emergency imaging and aortic referral.
A new diastolic murmur, heart failure or pericardial effusion can indicate root complication, acute regurgitation or haemopericardium.
Rapid growth, symptoms, saccular morphology or a diameter approaching the relevant segment threshold accelerates multidisciplinary repair assessment.
Young age, syndromic features or a family history of thoracic aneurysm, dissection or sudden death should trigger heritable aortic disease evaluation.
Abrupt severe chest or back pain, syncope, pulse deficit, neurological deficit or shock signals dissection or rupture.
Investigation priorities
Define root, ascending aorta and valve while mapping full aortic extent.
Management branches
Cross-sectional imaging reports a 51 mm ascending aorta in an otherwise stable adult.
- Confirm the exact segment, valve morphology, centreline-orthogonal maximal diameter and previous growth using original images and a consistent convention.
- Elicit pain or compression symptoms, blood pressure, family history, sudden deaths, syndromic features, pregnancy plans and previous aortic or valve surgery.