Thoracic aortic aneurysm 5.2 Advice-please

Because my aneurysm was already at 5.2 cm I first saw Estrera and he saw me very quickly. The surgeons that first found it recommended I saw a thoracic surgeon right away. I’m pretty sure I found Prakash through Dr Estrera’s office (their recommendation), and I’m so glad I did. Depending on where yours is at you may want to see Prakash first.

But if yours is large, close or over 5.0 then I would see Estrera first, having the surgeon’s referral will give you priority with Prakash and pretty much any other care you need.

Mine is at 4.5 and deemed as stable for past year. I had a stroke last year which is why the aneurysm was discovered. I will probably reach out to Estrera!s office next week.

We had surgery the same day.

I had my first thoracic aortic aneurysm diagnosis when my primary care doctor sent me for a Ct. for Coronary Calcium, and the aneurysm of 5.2cm was discovered. My doctor referred me to a cardiologist at Vanderbilt Medical Center in Nashville, Tennessee, who also requested for Ct, Chest, and W/Wo Contrast, and that result showed my aneurysm as 4.8 cm. When I inquired about why the two different measurements, the cardiologist explained that the first scan was without contrast and the result was overexaggerated, but the second test, W/Wo contrast, had a more accurate measurement of 4.8cm. I am currently in a six-month waiting period and will have the scan again in February 2025. I am worried as I do not know which of the results is accurate, and my situation may be more serious than the second test showed. I would rather have the surgery earlier than wait. What should I do? Can I request an earlier scan than the scheduled six months? Has anyone had the experience of two different measurements?

I had a very similar scenario. Had an inexpensive calcium CT scan (without contrast and without gating) last February 2024 which showed 5.0. Had a follow-up CT scan with contrast in September which showed only 4.8. The doctor explained that the earlier calcium CT scan essentially did not account for the movement of the heart which can lead to some inaccuracies and higher readings. A gated CT scan with contrast is going to be more accurate. Like you, I was planning to have surgery but now fall below the threshold for surgery under my insurance. I am scheduled for a follow-up scan in one year. I have basically resigned myself to waiting and watching. Historically, these things tend to grow on average at the rate of 0.1 cm per year, but can sometimes plateau for a while. So, I suspect it will get larger, and that surgery will be required at some point, but when that will occur remains uncertain.

Your experience with measurements match my own. Mine was found on a Calcium CT. Then I got a chest CT with contrast and it was a few tenths of a centimeter smaller. I've had a couple of measurements since then, and each one was with and without contrast. They do the scan once, then inject the contrast and do it again. The measurements are always a few tenths of a centimeter different and the one w/o contrast is always larger. I'm not really sure why they do the one without contrast, except perhaps a sanity check of some kind? I've recently learned too that there are gated and non-gated CT scans. A gated scan can account for where your heart is in its cycle. It should be more accurate than non-gated. If you're going to Vanderbilt, I'd guess it's a gated CT. I'm in a rural area and our CT machine is non-gated.

I'd guess whether you can get surgery depends on your other medical conditions and how conservative your surgeon is. I think it's unusual to ever get surgery under 5cm unless you have a rare genetic condition, and usually it's 5.5 unless there are other factors. Here's a link to the relevant guidelines I think, if you want to dig into it: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001106. They wait until the probability of a bad outcome without surgery is greater than the probability of a bad outcome with surgery. Everyone thinks they're going to be the one without a bad outcome and almost everyone is. Once in a while, though, there will be someone on these boards that had a bad outcome from an elective surgery. It does happen, though rarely.

So I've decided my approach is to find a surgeon I trust that has lots of experience (the most important step), and then trust they have far more expertise than I do, have more experience than I do, are more impartial than I am and, hopefully, has my best interests at heart.

Do you have any symptoms from this aneurysm I was wondering because I have had Thoracic Outlet Syndrome front and back for many year's?

Totally get why you'd be concerned. You are going to be fine. You know you have a problem at that's 95% of the solution. It’s actually pretty common to see slight differences in measurements, especially between a scan with contrast and one without. The contrast helps define things more clearly, so the cardiologist is probably right that the 4.8 cm measurement is more accurate. That said, I understand wanting to be extra cautious. If waiting six months feels too long, there’s no harm in asking for an earlier scan—lots of people do it for peace of mind. Or, if you're still uneasy, maybe even get a second opinion just to feel more confident in the plan. It’s not unusual for people in this situation to get slightly different readings and end up with everything being okay. But, if getting a re-check sooner helps you sleep better, it's worth the ask! I suddenly and completely dissected in 2015. It was a nightmare and you don't want that, so listen to your doctors. Peace.

Thank you all for your responses and insights. I am more at peace now having read your posts. Thank you so much.