Diagnosing Aortic Aneurysm

At NYU Langone, a team of cardiothoracic and vascular surgeons works together to diagnose an aortic aneurysm, which is a bulge that develops in the wall of the aorta, the largest blood vessel in the body.

The candy cane–shaped aorta extends from the heart upward into the chest and then bends downward into the abdomen. Aortic aneurysms can occur anywhere in the aorta, but they’re most often found in the abdominal aorta, the part that lies below the rib cage.

Chronic, uncontrolled high blood pressure, a family history of the condition, and smoking are among the most common risk factors for aortic aneurysm. Another risk factor for aortic aneurysm is having high cholesterol levels, which can lead to atherosclerosis, a hardening and narrowing of the arteries. This condition occurs when plaque—which is an accumulation of fatty substances and waste products on the wall of an artery—causes the layers of the aortic wall to erode. Men and people older than age 65 are more likely to have aortic aneurysms.

People with chronic aortic dissection, which is a tear in the aorta, and those with certain inherited conditions that affect the heart, such as Marfan syndrome, also are at an increased risk for aortic aneurysm. Another condition that can increase a person’s risk of an aneurysm is a bicuspid aortic valve, in which the valve that prevents backward blood flow into the heart has two leaflets, or flaps, instead of three.

Sometimes, an injury caused by a sudden blow to the chest or abdomen—such as a car accident—can damage the aorta and lead to an aneurysm.

Symptoms of Aortic Aneurysm

Most aortic aneurysms don’t have symptoms, and many are discovered unexpectedly after a person has a CT scan for other reasons.

When an aneurysm begins to expand, tear, or leak blood, it can cause several symptoms. Some people feel pain, which can occur in the abdomen, chest, or lower back. Others feel a pulsing sensation in the abdomen.

Painful bruising in one or more toes may also occur. This is caused by a blood clot that travels from the abdomen and blocks blood flow to the legs or feet.

An abdominal aortic aneurysm can develop slowly over the years without having any symptoms. Thoracic aortic aneurysms symptoms usually don’t occur until the bulge begins to leak blood, tear, or expand. These symptoms may include a rapid heart rate, chest or upper back pain, nausea and vomiting, hoarseness, and trouble swallowing.

The larger the aneurysm, the higher the risk of a tear in the artery, which is known as an aortic dissection and can lead to a rupture. Both conditions are life threatening. Anyone experiencing the symptoms of an aortic dissection or aortic aneurysm should go to the emergency room immediately.

Diagnostic Tests

To diagnose an aortic aneurysm, NYU Langone doctors perform a physical exam and ask about your medical history. They may also recommend several tests if they suspect an aortic aneurysm.

CT Scans

In this test, X-rays are used to produce cross-sectional computer images of the chest and abdomen. Before the test, a substance called a contrast agent, which makes the aorta more visible during the scan, is injected into a vein in your arm.

MRI Scans

An MRI scan uses a magnetic field and radio waves to create images of the aorta. These are sent to a computer to be analyzed by a radiologist and your doctor.

This test helps your doctor determine the location and size of the aortic aneurysm. During an MRI, you lie inside a machine that contains a strong magnet.

Ultrasounds

An ultrasound uses sound waves to produce images of the abdomen. It provides a clear view of the abdominal aorta, the part of the aorta that extends below the diaphragm. The images are sent to a computer for analysis by your doctor.

Doctors at NYU Langone may use duplex ultrasound. This imaging test combines traditional ultrasound with Doppler ultrasound, which measures the direction and speed of blood flow.

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