From the Guidelines
For an incidental finding of an ascending aortic aneurysm measuring 43x47mm on chest CT, I recommend referral to a cardiovascular specialist for evaluation and management, with a focus on blood pressure control, surveillance imaging, and lifestyle modifications to slow aneurysm progression and prevent complications. This finding represents a moderate aortic dilation that requires monitoring but not immediate surgical intervention. Management should include blood pressure control with a target of <130/80 mmHg, typically using beta-blockers (such as metoprolol 25-100mg twice daily) or angiotensin receptor blockers as first-line agents, as suggested by 1. The patient should undergo baseline echocardiography to assess valve function and confirm measurements, followed by surveillance imaging with CT or MRI every 6-12 months to monitor for growth, as recommended by 1. Key considerations in management include:
- Growth rates exceeding 0.5cm per year or development of symptoms (chest pain, shortness of breath) would warrant consideration for earlier surgical intervention 1
- Lifestyle modifications are important, including smoking cessation, moderate exercise without heavy lifting or straining, and avoidance of stimulants
- Surgical repair is generally recommended when the ascending aorta reaches 5.0-5.5cm in diameter, depending on patient factors like family history, connective tissue disorders, or growth rate, as indicated by 1 and 1. This management approach aims to slow aneurysm progression and prevent potentially catastrophic complications like aortic dissection or rupture.
From the Research
Management of Incidental Finding of Ascending Aorta Dilation
- The management of an incidental finding of ascending aorta dilation (43x47mm) on a CT scan of the chest involves further evaluation and monitoring to assess the risk of aortic complications, such as dissection or rupture 2.
- Transthoracic echocardiography (TTE) is a useful imaging modality for assessing aortic size and biophysical properties, and can be used as an initial modality in the emergency setting 3.
- TTE has been shown to be reasonably accurate for assessing ascending aortic dimension, with a strong positive correlation with transesophageal echocardiography (TEE) 4.
- The choice of imaging modality and measurement method can affect the accuracy of aortic measurements, with TTE SAX mid-diastolic L-L method showing unbiased agreement with CTA I-I method for sinuses measurement, and TTE LAX end-diastolic L-L method showing unbiased agreement with CTA I-I method for Asc-Ao measurement 5.
- The prevalence of incidental ascending aortic dilation is approximately 2.7% in older patients, and the risk of aortic complications is low, with only 3.7% of patients demonstrating interval growth over a mean follow-up period of 3.4 years 2.
- Current guidelines for surveillance imaging of aortic dilation may need to be revised to increase the follow-up interval and/or improve risk stratification to better identify patients at high risk of disease progression 2.
- In cases where an aortic thrombus is incidentally found, treatment modalities such as systemic anticoagulation, endovascular, and/or surgical intervention may be considered 6.