Definition
An aortic aneurysm is a bagging of the vessel wall or vessel walls. At least one layer must be affected to meet the definition.
Symptoms
An aortic aneurysm is a pathological dilation of the aorta. It occurs either in the chest or abdomen. In the abdominal cavity there are no symptoms at first, so it is difficult to detect the aneurysm early.
The unspecific symptoms can easily be confused with other diseases, such as a heart attack. As it increases in size, it presses on the surrounding organs and can lead to discomfort. Above a certain size, it is sometimes possible to palpate the aneurysm pulsating on the abdomen.
It can also lead to diffuse back pain. An aortic aneurysm in the chest causes complaints such as coughing, hoarseness, chest pain, shortness of breath and difficulty swallowing. A rupture causes very severe pain in the abdominal or chest area with radiation to the back.
The following high blood loss leads to a circulatory collapse with shock symptoms and is an acutely life-threatening situation. An aneurysm in the abdominal cavity initially causes no symptoms. If it increases in size, it can lead to pain in the lower abdomen, which can radiate into the legs.
Diffuse back pain is also possible. In the chest, an aneurysm causes chest pain. In addition, swallowing difficulties and shortness of breath can occur.
A rupture of the aneurysm causes extremely strong pain in the chest or abdomen, depending on its location. Hoarseness can be a symptom of a thoracic aortic aneurysm. Above a certain size, the aneurysm can affect the laryngeal recurrens nerve. This nerve innervates a large part of the muscles of the larynx. If the aneurysm now presses on this nerve, recurrent paresis occurs, resulting in hoarseness.
Diagnosis
First and foremost is the patient survey (anamnesis) and the clinical examination. During the anamnesis especially possible concomitant diseases have to be asked. If the patient indicates that he/she suffers from coronary heart disease, the suspicion of an aortic aneurysm must be taken into consideration (55% of cases).
Other diseases that are frequently found as concomitant diseases are high blood pressure and arterial occlusive disease, heart failure and diabetes mellitus. During the physical examination, the doctor must examine the abdomen more closely. Palpation (palpation) and listening to the abdomen with a stethoscope (auscultation) may give indications of an abdominal aortic aneurysm (typical: buzzing, murmuring, pulsating).
If an aortic aneurysm is suspected, an ultrasound examination must be performed. In many cases, this may indicate a bulging of the aorta. A special setting (colour Doppler) allows the doctor to check the colour of the blood flow in the vessel.
Unnaturally large turbulences would also indicate an aneurysm. The diameter of the aorta is also important for the ultrasound examination. If a standard value of 2.5 cm is exceeded, this is called aorticectasia (2.5 cm-3 cm).
A diameter over 3 cm is then called an aneurysm. During the ultrasound examination, the search for free fluid should not be forgotten, the presence of which could indicate an aneurysm that has already ruptured. Computer tomography (CT), which in this case should be performed with a contrast medium, can also be used to visualise an aneurysm.
The CT cross-sectional image usually shows a crescent-shaped sacculation or a so-called “mirror image”, which is missing in the remaining areas of the vessel. Clotted blood (thrombotic material) that has already formed at the aneurysm can also be made visible in the CT image. It is also important to check the outgoing vessels (e.g. renal vessels), as the blood supply to the adjacent organs must be guaranteed.
Alternatively, magnetic resonance imaging (MRT) can be performed. This takes much longer than CT, however, and is more of a second choice method, especially in emergency situations (ruptured aortic aneurysm). In the further course of the procedure, it is essential to examine additional arteries for aneurysm formation. In many patients, renal artery and carotid aneurysms exist in addition to the aortic aneurysm. The diagnostic tool of choice here is the ultrasound examination.
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