Aortic Aneurysms - 4.5CM - Bicuspid Valve

Posted by Fighter @niravani, Sep 4 3:51pm

I am 50 year old male and diagnose with Aneurysms by accident through CT scan. 4.5CM was the measurement in December 2023. Since I met with Cardiologist and Surgeon and they ask to repeat CT scan and ECHO 6-month later.
I did re-test those and pretty much CT scan showed 4.6CM but a note that compare to the last one, its unchanged and stable.
My Dr. ask to do again in December and if its stable, repeat only ever year.
I went to Cleveland Clinic yesterday as I want to do my surgery there when it comes a time and they did the ECHO that showed my aneurysm of 5.3CM!!!! How is that possible? I just had my ECHO and CT scan in June (2months ago) and they both were 4.6CM and 4.3CM respectively and how Cleveland Clinic result is 5.3CM?

AORTA
The visualized aorta is dilated.
Measurements - Sinus: 3.5 cm.
Mid ascending aorta 4.7 cm.
Distal ascending aorta 5.3 cm.
Mid arch 2.9 cm.

This is scary and don't know what to do! Any advise? Any similar experience?

Interested in more discussions like this? Go to the Aortic Aneurysms Support Group.

bitsygirl | @bitsygirl | Sep 24 9:43am

In reply to @niravani "Hello Everyone, so Cleveland clinic Cardiologist don't really know as how ECHO can show so much..." + (show)

This was a reply to Fighter but it's not showing up that way for me.

Where did you decide to get your scan?

Good luck! Hopefully the 5.3 was an error somehow.

Fighter | @niravani | Sep 24 10:25am

Hello All, want to update everyone. Finally I did got the new CT done to confirm. It came at same as June 2024 CT, which is 4.6CM. Below is now the summary:
12/2023 - CT - 4.5CM
12/2023 - TEE - 4.5CM
12/2023 - ECHO - 4.1CM
6/2024 - CT - 4.6CM
6/2024 - ECHO - 4.4CM
9/2024 - ECHO - 5.3CM (At Cleveland Clinic)
9/2024 - CT - 4.6CM (showing un-changed)
This is sure a relief and I have an appointment with cardiologist and surgeon in December 2024. I believe at that point, they will likely do another scan 12-month down in 2025.

Fighter | @niravani | Sep 24 10:26am

In reply to @bitsygirl "This was a reply to Fighter but it's not showing up that way for me. Where..." + (show)

Thank you. CT shows 4.6CM and shows stable in compare to previous CT's. So, this ECHO at Cleveland clinic was just terrible either in measurement or an error.

bitsygirl | @bitsygirl | Sep 24 10:47am

In reply to @niravani "Thank you. CT shows 4.6CM and shows stable in compare to previous CT's. So, this ECHO..." + (show)

Good news! Really odd about the Cleveland Clinic ECHO. I thought they'd be better and pursue the error. Must not be uncommon.

Fighter | @niravani | Sep 24 11:15am

In reply to @bitsygirl "Good news! Really odd about the Cleveland Clinic ECHO. I thought they'd be better and pursue..." + (show)

I hope that is uncommon at Cleveland clinic. They didn't had a good explanation. Cardiologist confirm that she even looked at that herself and that the person doing the ECHO report is their best experience person so how come it shows 5.3CM vs. 4.6CM is mystery.
I know there can be differences but I wasn't aware that it will be 0.7CM of differences!!

bitsygirl | @bitsygirl | Sep 24 3:03pm

I asked perplexity.ai and chatgpt.com "What is the variation in measurement of an ascending aortic aneurysm by echocardiogram versus CT"

perplexity.ai said:
Bland-Altman analysis revealed a bias of -1.6 mm with wide limits of agreement from +5.6 to -8.9 mm for the ascending aorta when comparing echocardiography to CT measurements. This indicates that echocardiography tends to overestimate the aortic diameter compared to CT, with potential differences of up to 8.9 mm in either direction.

ChatGPT was much less useful, it said:
It's not uncommon for measurements to differ by several millimeters between the two modalities, with CT generally considered more accurate for aneurysm size determination.

Of course, AI is as the name implies ... artificial. But if they are right, I guess that explains it. Who knew. Maybe that's why the Cleveland Clinic cardiologist seemed to dismiss it.

rogerdhorton | @rogerdhorton | Sep 24 4:02pm

In reply to @niravani "Thank you. CT shows 4.6CM and shows stable in compare to previous CT's. So, this ECHO..." + (show)

If still uncertain, I assume it would be possible to direct the Cleveland clinic to send the ECHO result to another clinic for a “second opinion” ? Not wanting to sound alarmist.

Best of luck and good fortune from a fellow warrior / worrier 🤕

Fighter | @niravani | Sep 24 5:00pm

In reply to @rogerdhorton "If still uncertain, I assume it would be possible to direct the Cleveland clinic to send..." + (show)

Even Cleveland Clinic cardiologist came back stating that is a great news. She will call me on Thursday to review this report. When it comes to Aorta and defining size and accuracy, CT is the gold standard and measurement of ECHO should not even be bothered.
ECHO is a good tool to analyze four chambers of heart, blood pumping, valves and functionality of those valves, stenosis etc. Just not the Aorta and measurement.

I am good with CT scan results now.

Good news is that, Since December 2023 when I first found this to now through three different CT scans using three different CT machines (I had CT done at different locations within the hospital franchise here), they all shows stable and 4.5/4.6 reading.

I focus on daily exercise (elliptical and walk) for 1 hour, no drinking of alcohol and controlling blood pressure through couple of medicines. Hope that will do it as long as possible and when it comes a time to operate, it is what it is.

Thank you all on this chat to listen and sharing my experience.

pamela78 | @pamela78 | Sep 25 8:51am

In reply to @niravani "Thank you. CT shows 4.6CM and shows stable in compare to previous CT's. So, this ECHO..." + (show)

If it was an error, it's disconcerting to say the least.

Fighter | @niravani | Sep 25 10:07am

In reply to @pamela78 "If it was an error, it's disconcerting to say the least." + (show)

And all the stress for 3 week period!

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