Internal Medicine

Thoracic aortic aneurysms (TAA)

Abnormal dilatation/bulging in a blood vessel due to the intrinsic weakness of the vessel wall.


Abnormal dilatation/bulging in a blood vessel due to the intrinsic weakness of the vessel wall.


Risk factors:

  • Male gender
  • Increased age
  • Hypertension
  • Chronic obstructive pulmonary disease (COPD)
  • Coronary artery disease (CAD)
  • Smoking
  • Previous aortic dissection
  • Family history of TAA (strong risk factor, 20%)

Syndromic association (5% cases):

  • Marfan syndrome
  • Loeys-Deitz syndrome
  • Ehlers-Danlos syndrome

Clinical features

Rarely manifest with symptoms, and about 95% of the patients are asymptomatic. If they become large enough, they may occasionally cause symptoms.

  • Chest pain (because of compression of adjacent structures)
  • Difficulty breathing (d/t airway compression)
  • Hoarseness of voice (d/t compression of recurrent laryngeal nerve)


22% of individuals die before reaching the hospital during an aneurysm complication

  • Aortic dissection/rupture: . Chest pain radiating to the back with severe hypotension
  • Superior vena cava (SVC) syndrome


  • Contrast-enhanced CT (CECT) scan (M/C)
  • MRI
  • Transesophageal echocardiography (TEE)
  • Ascending aortography
  • PET scans
  • Chest x-ray
  • Electrocardiogram (EKG)


Lifestyle modifications:

  • Smoking cessation
  • Diet to control hypertension

Medical management:

Aims at reducing stress in the aorta, which in turn prevents the growth of the aneurysm
  • β-blockers (first-line drugs): Reduce stress by decreasing both blood pressure and contractility
  • Angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors: Beneficial for patients with Marfan syndrome as they reduce TGF-B signaling
  • Lipid-lowering agents (statins): Reduce oxidative stress, rate of rupture, and dissection

Surgical management:

Aims to prevent dissection or rupture of the aneurysm
  • Cutoff for surgery:
    • Ascending aorta: 5.5 cm
    • Descending aorta: 6.5 cm
    • Ascending aneurysm (asymptomatic case with Marfan syndrome): 5 cm

2 replies on “Thoracic aortic aneurysms (TAA)”

Thanks for the feedback. A simplified explanatory video has been put up at the start of the article. Hope it helps.

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