aortic aneurism and/or dilation aorta?

[aaquestions]

One year ago a CT scan with contrast was done with report as follows:

FINDINGS:  Thoracic aorta appears within normal limits.  The ascending aorta measures up to 4.2 cm.  There is no evidence of aneurismal dilation.  The aortic arch and descending thoracic aorta appear within normal limits.  The upper abdominal aorta also appears to be normal.  The major aortic branches appear unremarkable.  

IMPRESSION:  No evidence of aneurysm or dissection of the aorta.  No focal pulmonary abnormalities.  


Now most recent CT scan with contrast (done in a different facility) report reads partly as follows:  

There is a small ascending aortic aneurysm.  Ascending aorta is dilated.  Maximum dimension of the ascending artery at the level of the main pulmonary artery measure 40 X 41 mm in maximum dimension consistent with mild dilation of the ascending aorta.  

Are these pretty much the same reports or has there been a change?
Thank you!!  

[Cleveland Clinic]

Yes the reports show that it has really not changed in the interim. Aortic dilatation in the ascending aorta is any diameter greater then 3.7 cm, whereas an aneurysm is 1.5 x that diameter. Aortic surgery is usually reserved for symptomatic, rapidly expanding or large aneurysms. The cutoff for surgery varies from institution to institution and if Marfan's syndrome or a bicuspid aortic valve is present. At our institution we operate on ascending aortas greater than 5.5-6 cm, or earlier if the patient is symptomatic or has Marfan's syndrome.

[pbanders]

The two reports appear the same, the difference is in the interpretation of what constitutes an aneurysm. The doctor's word here is what you should go by, but from what I know, aortic dilation in excess of three standard deviations from the norm (the "Z-score") for your specific body surface area (BSA) is considered to be an aneurysm. When the aneurysm exceeds 5.0 cm, surgery is usually recommended to graft and repair the aneurysm to prevent aortic dissection. Looks like you showed no progression in a year, which is good.

[aaquestions]

Thank you for your helpful comments.  How do I find if measurement is in excess of 3 standard deviations from the norm for specific BSA?  By the way, patient is 48 years, female, and very petite.  Do "dilation" and "aneurism" have roughly the same definition, meaning the ascending aorta at 40 X 41 mm is an "aneursim", basically synonymous with dilation?  Can the ascending aorta measured at 4.2 cm, by virtue of it being above 3.9 (top range of ascending aorta, according to some) be considered dilated?  Semantics, I guess?  I don't like that the year ago report specifically said "no evidence of aneurismal dilation", yet the current report indicates otherwise.  I'm assuming the dilated ascending aorta has a small aneurism somewhere near the level of the main PA and that wasn't seen last year.  Follow up with doc is during/after a stress echo after the holidays.  Thanks again for helping!!!  

[Shelster56]

Hi,

Just wanted to let you know I'm in the same boat - 52, very small, and have an aneurysm that measured 4.5 last year.  My cardio considers this "mild," but have to say I'm a bit more concerned than she seems to be. From what I've read, small people (and those like me with a bicuspid aortic valve) may need surgical intervention before the standard 5cm normally recommended.

I was told last year that I would have another CT scan this year, but now I've been told that a CT may not even be done this year.  It depends on the results of my annual echocardiogram.

This really confuses me.  I had an echo and a CT done at roughly the same time last year and the aneurysm only showed up on the CT.  I've never thought that echos show aneurysms.  Anyone know if they do?

An aneurysm surely is a scary thing.  I've already had two open heart surgeries and don't relish the thought of another.

Best wishes.  

[pbanders]

The patient's cardiologist has the charts that show the range of aortic diameters as a function of BSA. The doctor here gave a more general definition, and your cardiologist may have yet another, as there seems to be a range of opinons as to the definition of aortic dilatation, aortic aneurysm, and the threshold for surgical intervention. For the most part, the terms dilatation, dilation, and aneurysm are all describing the same thing, the aorta's diameter is bigger than normal. The shape of the aneurysm is indicated by the fact there are two dimensions given. If the two numbers are the same (e.g. 4.0 x 4.0 cm), it means the aneurym is symetrical. If they're not, then it bulges, which may be more significant, and from what I know, is often the type of aneurysm seen with Marfan's.

Regardless, the good thing is that the condition is known and is being monitored. Typical growth rates for aneuryms are very low, under 0.1 mm/yr, though some do grow rapidly which is why they need to be monitored. Drug therapy also seems to be able to slow the growth (beta blockers, irbesartan, losartan). The fact that the arch and the thoracic aorta aren't involved means that should surgery become necessary, it will be considerably less complex and risky. I had surgery in 2004 at age 46 for a 5.0 cm aneurysm of the ascending aorta and today I lead a totally normal, active life.

[aaquestions]

Thank you so much!!  So very helpful and I'm appreciative of your time and advice!!  Have a terrific holiday!!