ANEURYSM OF THE AORTA
DEFINITION OF ANEURYSM OF THE AORTA
ANEURYSM OF THE AORTA ….It is a permanent localized dilatation of the aorta due to destruction of its wall.
TYPES OF ANEURYSM OF THE AORTA
- Congenital: This is present since birth and is due to defect in the medial coat. Aneuryssm of sinuses of Valsalva is an example of this. Anuloaortic ectasia with or without Marfan’s syndrome may also cause aneurysm.
- Traumatic Aneurysm just distal to the origin of left subclavian artery may develop due to trauma (dissecting aneurysm).
- Inflammatory: Syphilis was the commonest cause of such aneurysm previously but very rare now-a-days. Syphilitic aneurysm is due to development of mesaortitis and is usually confined to aorta and its large branches. Apart from aortic aneurysm syphilis may cause coronary osteitis and aortic incompetence.other causes like bacterial endocarditis or periarteritis nodosa may cause it….ANEURYSM OF THE AORTA
- Degenerative: It is mostly due to atherosclerosis which occurs in abdominal aorta (75%).
- Miscellaneous: Cystic medial necrosis, Marfan’s syndrome, Takayasu’s disease (proximal aorta) may also cause aneurysm of aorta.
Age: Usually over 30 years.
Sex: Males prodominate.
Aneurysm of the ascending aorta
This may produce dull chest pain due to erosion of the rib and a local bulging on the right side of the sternum. Aortic incompetence due to dilatation of the aorta and anginal pain due to coronary osteitis may develop. If the sac compresses the right bronchus there may be cough, collapse of the ung and secondary infection therefrom. If the aneurysm ruptures inside the bronchus fatal haemoptysis may result.ANEURYSM OF THE AORTA
Aneurysm of the arch
In this situation the sac of aneurysm usually compresses the mediastinal structures like great vessels, trachea, recurrent laryngeal nerves, oesophagus, etc., producing different features as given below.
Great vessels: Inequality of pulse on two sides.
Trachea: Cough, rarely haemoptysis if the sac ruptures.
Bronchus: Tracheal tug (Oliver’s sign)-This can be felt as a sensation of tug with each heart beat by keeping the index finger tips under the cricoid cartilage. This is due to filling up of the aneurysmal sac with each systole.
Oesophagus : Dysphagia (Dysphagia lusoria).
Superior vena: Bloated face, non-pulsatile engorgement of
Cava: jugular veins, increase venous pressure.
Recurrent: Hoarseness of voice, brassy cough or even | ANEURYSM OF THE AORTA
Laryngeal nerve: leopard howl.
Brachial: Neuralgic pain.
Plexus Sympathetic chain: Horner’s syndrome.
Phrenic nerve: Hiccough, parálysis of diaphragm.
Sternum or vertebra: Deep boring pain.
Aneurysm of the descending aorta
Only symptom is deep boring pain over the vertebrae due to erosion. Epigastric pulsation may be seen. On auscultation a systolic murmur may be heard over the sac.
In syphilitic aneurysms syphilitic stigmata may also be present anywhere in the body, particularly neurosyphilis in about 25% of cases.
- VDRL test may be positive in untreated syphilitic cases.
- X-ray of chest (PA) may show dilatation of the ascending aorta with calcification. Erosion of the rib or vertebra may also be seen.
- Ba-oesophagogram shows aortic impression aneurysm over the oesophagus.
- Aortic angiography may show irregularity and narrowing of the lumen of the aorta.
- ECG may show evidences of left ventricular enlargement due to aortic incompetence.
- Abdominal ultrasound may help to locate the lesion with its size.
- CT scan and MRI are similarly helpful as ultrasound.
- Most recently MRI angiography has been used as an alternative to aortography.
According to the underlying cause treatment is to be done. Symptomatic treatment particularly for pain is to be done by analgesics. Hypertension and hypercholesterolemia is to be controlled. Beta-blockers reduce the risk of aneurysm expansion and rupture. For aneurysm, surgical interference is also required.