I've recently moved and my GP in my current location ordered a "baseline" echo because I have a Bicuspid aorta and had been complaining of dull back pain for a few weeks.
The results were a bit unnerving. Supposedly, my aortic root measured at 3.8. This was an increase from the 3.2 measurement from the previous November (8 mos prior). Needless to say, this freaked me out. I contacted my cardiologist where I used to live and told him of the measurements. He was skeptical and asked if I could come back to see him and re-take the echo (he had given me my previous 4 echos). I went back to visit him and when they did the echo, they got a much smaller measurement. He said the aortic root measured 2.7. The technician also tried to measure the aorta from different locations just to be sure and got measurements of 3.3 and 3.5 (though I'm not sure what part of the aorta he was measuring).
So my cardiologist thinks things are fine. My GP doc can't explain the difference and wants to do another echo in 6mos.
In the meantime, I still have the occasional dull mid-back pain next to my spine (it may very well be muscle related - as I work out every day and also slouch over a computer every day). I asked both of my doctors if this could be a symptom of an aortic aneurysm. They've both said that's probably not the case.
So my question is, how could there be such variation in echo reports? Should I request a CT scan to get a completely accurate measurement? Would any aortic aneurysm most likely be discovered during an echo or even a chest xray?
I worry about these things due to BAV, but thus far my echos have been pretty good. Only trace regurgitation at the valve... everything else normal. I'm 34, athletic and my bp is under control with meds (125/70 last reading).
Thanks for your expertise.
The answer is yes you should get a CT scan because the echos only address the most proximal part of the aorta, and are often not perpendicular to the aortic axis. The ascending aorta has a curved course, and especially in people with aneurysms, this course can be very difficult to predict and image by echo.
CT will make sagital cuts and will display the aorta in its greatest diameter with post processing. This way the problem with different views on different echos is minimized and the true diameter of the aorta is actually measured. The only downsides are contrast exposure and radiation exposure. So limit these to once per 1-2 years. The CT will also look at the descending aorta, and since you are having dull back pain you actually may have a problem in the descending aorta.
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