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Thoracic aortic aneurysm
A thoracic aortic aneurysm is a swelling of the aorta in the thoracic region that results in an abnormally dilated, deformed, tumor-like protrusion. About 80% of thoracic aortic aneurysms are secondary to hypertensive atherosclerosis and 14% are caused by syphilis. Most occur after age 60.
Thoracic aortic aneurysms are slow in onset, mostly asymptomatic in the early stage, and causes symptoms in the late stage due to compression of the surrounding tissue. The clinical manifestation for each patient is different due to the size, shape, and location of the growth. For instance, compression of the trachea and bronchi can cause coughing, shortness of breath, pneumonia, and atelectasis. Compression of the esophagus results in difficulty swallowing while compression of the recurrent laryngeal nerve causes hoarseness. Additionally, pressure on the phrenic nerve can cause paralysis of the diaphragm and compression of the superior vena cava and cephalic vein can cause swelling of the upper limbs, neck, and face.
The natural history of thoracic aortic aneurysms is dependent on a number of factors such as the rate of enlargement and the risk of rupture. Symptomatic patients have a worse prognosis than asymptomatic ones. Additionally, the size of the aneurysm and the rate of expansion are also risk factors for the risk of rupture. For instance, thoracic aortic aneurysms with a diameter of 7cm are more prone to rupture than those with small diameter.
Thoracic aortic aneurysm is often accompanied by severe systemic atherosclerosis or cardiovascular disease, which can significantly increase fatality rate. In fact, many patients die from complications of atherosclerosis before aneurysm rupture.
Long-term follow up of thoracic aortic aneurysm showed that the 5-year mortality rate was 50% while the 10-year mortality rate was 70%. Half of the deaths were from accompanying vascular disease while a third of the deaths were from aneurysm rupture. Additionally, mortality was independent of the aneurysm location. Patients with advanced age, aneurysm size greater than 6cm, and associated hypertension or other cardiovascular diseases experienced increased mortality rate.
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AGAINST DISEASE
 

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