Thoracic Aortic Aneurysm

[JDOLERHIEGRIFFITH]

My husband has a thoracic aortic aneurysm and I am confused by his CT scans.  He was diagosed with this after leaving work in an ambulance with chest and shoulder pain and his blood pressure was like 200/110 when they found it.  On the CT in 2008 it says:  Again seen is the point of transition of the aneursym at the level of the aortic arch.  The aortic arch aneursym has a transverse diameter of approximately 4.3 cm.  Impression:  Aneurysmal dilation of the thoracic aorta, with a maximum transverse diameter of the proximal descending aorta of approximately 4.3 cm.  Tortous aorta by the hiatus.  On the CT report from 2009 it reads: There is enlargement of the aorta, beginning at the aortic arch and extending into the diaphragm hiatus. The aorta measures 4 cm at its largest point which is the proximal portion fo the descending aorta.  On the CT report form 2010 it reads: There is aneurysmal dilatation of the descending thoracic aorta.  Dilatation is most pronounced near the aortic arch with maximum measured diameter of 4.5 X 4 cm.  I can't find the one from 2011 but the CT from 2012 says: There has been slight interval enlargement of the proximal descending thoracic aortic aneurysm which measures 4.2 X 4.5 cm on the current exam compared with 4 X 4.5  on prior.  He also had an angiogram in 2012 it says ascending aneursym noted 5 cm.  My question is what does this all mean?  Sometimes I see it called an arch aneursym, sometimes descending at times I see ascending mentioned but only on the angiogram.  Then the one from 2009 said "There is enlargement of the aorta, beginning at the aortic arch and extending into the diaphragm hiatus".  Does this mean his entire thoracic aorta is enlarged?  What does it is very tortuous by the hiatus mean?  Thank you for your assistance

[ed34]

I was wondering if any Doctor has said anything about 5cm being the limit for enlargement? Only I've heard of patients with 5.2cm still on medication and stable.

[ed34]

Hi
   Oh my, where to begin. First let's look at the Aorta, the largest artery in the body. It leaves the top of the left Ventricle after the Aortic valve and travels a short distance upwards (ascending). It then gently curves around to face downwards towards the legs (aortic arch) and then travels downwards through the chest and into the abdomen (descending).
Now the hiatus. When we breath, the large Diaphragm moves up and down to increase/decrease pressure around the lungs in the chest, to draw air in or expel it. If is basically a covering across the inside of the body, in the lower chest and so it needs holes for things to pass through it. For example, there is a esophagal hiatus which is an opening for your food tube to pass through it, so it can get to the stomach which is below the diaghragm. The Hiatus is a ring of muscle, a sphincter, like on the human anus. There is a Aortic hiatus also, where the aorta passes through. The word Tortuous usually refers to a vessel when it is twisty rather than straight. It doesn't mean it is kinked, it is just curved.
So the reports seem to suggest the Aneurysm is affecting the ascending, the arch and descending up to the hiatus. However, from previous reports the enlargement seems pretty stable, so I assume he is on medication which is holding things back. It isn't so much as to how much is enlarged, it's more important how much it is enlarged. Obviously as the vessel enlarges, the walls become thinner, making it weaker and more likely to rupture. They will be keeping an eye on the thickness of the wall and recommend surgery should he be seen as a high risk of rupture.