Aneurysm on ascending thoracic aorta on CT scan not on angiogram

A lung cancer screening CT is usually not optimized to measure the ascending aorta. The ascending aorta moves with every heartbeat, and if the scan is not ECG-gated, motion can make the aorta look larger than it really is. Measurements can also differ depending on whether the radiologist measured straight across an axial image or measured perpendicular to the centerline of the aorta, which is usually the better method. A CT angiogram is usually ordered because it gives a more focused look at the aorta, the vessel wall, the lumen, and the exact dimensions. If the CTA was done with the right protocol, especially if it was ECG-gated or otherwise technically adequate, I would generally put more weight on that study than on an incidental measurement from a lung screening CT. That said, I would not just ignore the discrepancy. I would ask the cardiothoracic surgeon one very direct question: “Did you personally compare the lung screening CT images with the CT angiogram images, and what was the actual measured diameter of the ascending aorta on the CTA?”

You are not making anyone mad by asking that. This is exactly the kind of question that should be asked. A reported 4.3 cm ascending aorta is not usually an emergency, but it is important enough to clarify because future follow-up depends on whether the aorta is truly enlarged and what the accurate baseline measurement is. I understand why this kind of conflicting report would be unsettling. The practical next step is not to challenge the doctors emotionally, but to ask for a clear image-to-image comparison and the exact measurement method. If the answer still does not make sense, getting a second read from an aortic center or another cardiothoracic surgeon is reasonable. Peace.

I actually joined this group 3 weeks ago because I was diagnosed with a 3.4 abdominal aortic aneurysm by a US, which is what most use for sizing and monitoring. The fear and anxiety I have experienced is something no body can explain unless they have been through it. I am going to tell you always get a second test if you don’t feel right. I asked for a MRA to get a baseline of what I was working with. Had the MRA yesterday and as of 11:00 today 5/4 I have a normal 1.7 suprarenal and a normal 1.5 infrarenal. The Doctor told me the MRA is 100% accurate Praise the lord I was misdiagnosed. I definitely don’t want my blessings to bring anyone down. There is a place in my heart already for everyone in this group and will pray for everyone fighting this awful diagnosis. Don’t be scared to be your own advocate!!

@moonboy
Thank you so much. You have given me a place to start.

@afox2910
Thank you for giving me another option. I’m hoping the first one was wrong.

I say repeat the test...ct scan....and don't avoid questioning anything you're unsure about regarding your health!! Making a doctor "mad" should be the least of your concerns....and maybe a change of doctor may help if they do get mad.

My husband has a 5 cm abdominal aortic aneurysm that did not get smaller after coils and glue were placed 6 months ago. The interventional radiologist was able to control the front but now has to do it again in the back of the aneurysm because blood is leaking in. My husband also has orthostatic hypotension and can faint with low blood pressure, thus takes Midodrine which could raise blood pressure and be bad for his aneurysm. He is also diagnosed with Parkinsonism. With all these issues, should he go to the Mayo Clinic in AZ or MN?