Senile ectasia of aorta
Patient presents with dysphonia.
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There is a markedly thoracic aorta ectasia, especially in the ascendant and aortic arch, with diffuse parietal atherosclerotic calcifications.
An increased cardiothoracic ratio as a result of enlargement of the cardiac silhouette due to pericardial effusion.
Lungs are clear.
Radiography chest shows a common finding observed in elderly patients - atherosclerotic senile ectasia of the thoracic aorta. In this case is causing compressive mass effect on the left recurrent laryngeal nerve and consequent paralysis of the vocal cord. This is termed Ortners or cardiovocal syndrome.
The term aneurysm is used when axial diameter of the thoracic aorta is >5 cm and when it measures 4-5 cm the term dilatation is used 1.
Asymptomatic aneurysmal dilatation <6.5 cm is treated conservatively, and monitoring every 6-12 months. The choice of imaging techniques for evaluation of this pathology are CT and MRI with contrast. If the aneurysm is >6.5 cm, has annual growth >1 cm, or is symptomatic, intervention is considered because of the risk of rupture. In general, when possible, endovascular repair is the treatment of choice, with reduced morbidity and mortality 2.
- 1. Webb WR, Higgins CB. Thoracic Imaging. Lippincott Williams & Wilkins. (2010) ISBN:1605479764.
- 2. Atar E, Belenky A, Hadad M et-al. MR angiography for abdominal and thoracic aortic aneurysms: assessment before endovascular repair in patients with impaired renal function. AJR Am J Roentgenol. 2006;186 (2): 386-93.