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Ascending thoracic aneurysm: What should I do and not do?

Posted by mustangsally67 @mustangsally67, May 6, 2020

Last year I was diagnosed with a dilation, that measured 3.9 had a Thoracic CT on now it is 4.3. The cardiologist said to repeat in one year. Is this ok. I am 71 yrs old. Also what should I not be doing, and also what should I be doing

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debbie66 | @debbie66 | May 29 10:23am
In reply to @earlthepearl "I am also 81 and my "mildly dilated" ascending aorta was noted in '04 as result..." + (show)
Profile picture for earlthepearl @earlthepearl

I am also 81 and my "mildly dilated" ascending aorta was noted in '04 as result of seeing a Cardiologist for PVC's observed during my treadmill stress test. An Echocardiogram showed my AoD to be 4.4 cm. In 2007 a CT w c measured 4.8 cm. Since then, I have had 10 CT's showing the aorta to be anywhere between 4.4 to 5.0 cm. The latest was 4.8 cm. The Echo AoD's have ranged between 4.4 and 3.7 cm with the latest being 3.8 cm. Point being a dilated aorta does not necessarily mean the end is near. One thing I find fascinating is that the CT Program can extract an image of the aorta. Earl the Pearl

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@earlthepearl
Thank you!

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moonboy | @moonboy | May 18 5:06pm

Hey Jackie! Yes, it can be accurate. A PET/CT scan includes a CT portion, and that CT can show the size of the aorta. A 4.0 cm descending aortic aneurysm is the kind of finding that can be discovered while looking for something else. That said, a PET/CT is not always the best scan for making the final aortic measurement.

The usual next step is to confirm the finding with a dedicated aortic scan, such as a CT angiogram or an MRI/MRA. That gives the doctors a cleaner baseline measurement. The baseline is important because future decisions are usually based on whether the aneurysm grows, how fast it grows, and whether there are other risk factors. A single measurement is helpful, but the trend over time matters a lot.

A 4.0 cm descending aortic aneurysm is usually something to take seriously and follow, not something that automatically means surgery. Blood pressure control, follow-up imaging, and avoiding heavy straining or breath-holding are often part of the plan. The most important thing is to get connected with someone who regularly follows thoracic aortic disease. That way the finding can be watched calmly and consistently.

I had my own Type A aortic dissection in 2015, so I understand how scary it is to see the word aneurysm show up unexpectedly. The good news is that it was found, and now it can be followed instead of ignored. Ask for a dedicated aortic study and a clear follow-up plan. Peace.

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jackie4638 | @jackie4638 | May 18 3:33pm

I had a Pet/Ct scan that diagnosed me with a 4.0 descending aortic aneurysm. I was being tested for another cardiac issue. Can this be accurate?

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alfred456 | @alfred456 | May 16 7:07am

I would find a good Cardiothoracic surgeon- they are much more familiar with every aspect of Aneuryisims and be followed closely and you will be safe

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alfred456 | @alfred456 | May 16 7:04am

They are using more pharmacological treatments now to slow growth of AAA at Cleveland Clinic- statins, aspirin other anti inflammatories to interfere with path for growth I have a 3.8 for ten years stable but only 5 foot tall so if it grows as per Yale Aortic center in CT would need intervention in low 4s

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degarden_girl | @degarden_girl | May 11 4:27pm

@ewei6911 WOW, thanks for that information. I knew that Echos and CTs measured the aneurysm size differently, one straight across and one on the bias so the numbers will be different but I can't remember which is which.

Better than a CT is an MRI as it doesn't have the radiation. I think Echos are done more often because of that issue and I believe there needs to be a special type of MRI machine to measure an aneurysm and that machine is not available everywhere.

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ewei6911 | @ewei6911 | May 11 8:39am
In reply to @degarden_girl "Is this an ascending aortic aneurysm? How was the dilation found? CT or echo? If the..." + (show)
Profile picture for degarden_girl @degarden_girl

Is this an ascending aortic aneurysm? How was the dilation found? CT or echo? If the first test was a CT and now the second CT test indicates it has gone from 3.9 to 4.3, the rate of growth is about .4 centimeters in a year. In another 12 months, it might continue to grow at that same rate which would bring you to 4.7 which is still well below the size at which surgery is recommended. I think that is what your cardiologist is thinking.

You should be careful with lifting or anything else that might put a strain on you. My cardio recommends I not lift more than 25 lbs.

I think you would be wise to make a telemedicine appointment with your cardio to ask for more information and guidance. And you can also ask if you could have an echo in 6 months if that would give you comfort. The echo and CT measurements are done differently but your cardio should be able to interpret the results to see if the dilation is growing at an alarming rate. I am 75 and I have an echo every 6 months and a CT every couple of years. No radiation with the echo so if it continues to grow slowly, I'm OK with the echo monitoring.

I wish you good luck. I think you have no reason for panic at the moment but you can always get a second opinion from another cardio.

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@degarden_girl
My cardiologist tells me that an Echo does not give a full image of the aneurysm size, only partial, and that a CT scan is the best. Also the American Heart Association has change to 5.0 cm for women when surgery is indicated. So much information to absorb!

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cembalo80 | @cembalo80 | May 11 5:47am
In reply to @kimbarclay1 "Hi there! I presently have a second dilation of the ascending aorta aneurism above the diaphragm..." + (show)
Profile picture for kimbarclay1 @kimbarclay1

Hi there! I presently have a second dilation of the ascending aorta aneurism above the diaphragm it is 5cm in diameter. I already have a pre-existing aortic dissection that extends from my heart all the way down to femoral arteries. Part of the aorta has been replaced/repaired with Dacron back in 1996. I think I’m screwed as the surgeon doesn’t want to go to surgery so they doubled my blood pressure meds and suppose to be watching but with COVID everything has ground to a halt. I’m 52 female but I feel the outcome won’t be good but what I was wondering is I am having trouble swallowing food now and think it must be the pressure of the aneurysm on my esophagus ....does this seem plausible??

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@kimbarclay1
Yes, it seems totally plausible. Get a second and third opinion, just for starters.

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ctflyr | @ctflyr | Mar 7 7:29am
In reply to @oldwillie "Hi people, I'm a new guy. I'm 79 and have been following three anurisyms for years...." + (show)
Profile picture for oldwillie @oldwillie

Hi people, I'm a new guy. I'm 79 and have been following three anurisyms for years. An aortic root is now 5.3cm and one a couple inches up on the ascending aorta is about the same. My heart surgeon at Trinity in Hartford, CT., is very experienced and says it's time! I've been caring for my very ill wife for a long time and was hoping to try and hold off on surgury until she was gone. Do you think if I'm a couple of years older, that I may not be a good candidate for the surgery? I'm otherwise in fair shape. Maybe a little overweight and have parkenson's, but I do well with that! Any advice would be appreciated.

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@oldwillie
Hello.....lots of things to consider and prioritize in your case. Is there Family close by that can help you, either with your Wife's care, or yours if you have surgery? Your other health issues may govern your recovery if you have surgery. While it's sounds like you have great confidence in your surgeon, what is his experience level regarding open heart surgery, which is what you would have. Also, how well rated is the hospital you would use for this? It's important to have the best possible care before, during and after what could be considered a long and potentially difficult surgery and recovery. You need to be very realistic regarding your own physical condition and stamina to judge whether you could handle the aftermath of this very serious surgery. While the size of your aneurysms does dictate the need for surgery, you should have some very direct and frank conversations with your surgeon, and Family regarding the seriousness of what you're considering and the aftermath. You also might consider a "Virtual Second Opinion" that is offered on-line by Cleveland Clinic....considered one of the best aortic centers in the country. It is an out-of-pocket cost for this, but the expertise they provide is priceless. Best wishes in arriving at your decision and for your future health!!

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oldwillie | @oldwillie | Mar 6 1:31pm

Hi people, I'm a new guy. I'm 79 and have been following three anurisyms for years. An aortic root is now 5.3cm and one a couple inches up on the ascending aorta is about the same. My heart surgeon at Trinity in Hartford, CT., is very experienced and says it's time! I've been caring for my very ill wife for a long time and was hoping to try and hold off on surgury until she was gone. Do you think if I'm a couple of years older, that I may not be a good candidate for the surgery? I'm otherwise in fair shape. Maybe a little overweight and have parkenson's, but I do well with that! Any advice would be appreciated.

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