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Thoracic aortic aneurysm

When the aortic wall becomes weak, the artery may widen or bulge, this is called an aneurysm. When an aneurysm occurs in the chest area this is called a thoracic aortic aneurysm. 

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What is a thoracic aortic aneurysm?

The aorta is a blood vessel that carries blood high in oxygen from your heart to all parts of your body.

body in the centre with a normal sized aorta on the left and an enlarged aorta on the right

An aortic aneurysm is a swelling or bulging at any point along the aorta. An aneurysm usually occurs where the wall has become weak and has lost its elasticity, so it doesn’t return to its normal shape after the blood has passed through. A thoracic aortic aneurysm or TAA for short is a swelling or bulging of the aorta in the chest.

A thoracic aortic aneurysm can be life-threatening if there is a tear between the layers of the aorta's wall and it’s not treated immediately. The tear is called an aortic dissection. 

What are the symptoms of a thoracic aortic aneurysm?

Thoracic aortic aneurysms are often small and will grow slowly. Most of the time there are no symptoms which makes them hard to find. It can be difficult for doctors to know how quickly a thoracic aortic aneurysm may grow. 

As a thoracic aortic aneurysm grows, symptoms may include: 

  • back pain 
  • cough 
  • weak, scratchy voice 
  • shortness of breath 
  • tenderness or pain in the chest. 

If a thoracic aortic aneurysm bursts, symptoms may include: 

  • sharp, sudden pain in the upper back that spreads downward 
  • pain in the chest, jaw, neck or arms 
  • difficulty breathing 
  • very low blood pressure 
  • shortness of breath 
  • trouble swallowing 
  • loss of consciousness. 

If you experience any of these symptoms you or someone else should call 999 immediately. 

Depending on its size and growth, an aortic aneurysm may never burst or lead to a tear. However, if you have symptoms, it is very important to get medical help.  As the aortic wall enlarges, there is risk of the wall tearing, which can cause life-threatening bleeding, requiring emergency surgery.  

What causes a thoracic aortic aneurysm?

Aortic aneurysms can develop anywhere in the aorta. Causes of thoracic aortic aneurysms may include:

  • atherosclerosis  
  • high blood pressure
  • high cholesterol
  • genetic conditions - aortic aneurysms in younger people often have a genetic cause. 
  • congenital - a problem with the aorta or the aortic valve can develop in the womb.
  • blood vessel inflammation - conditions that can cause blood vessel inflammation, such as giant cell arteritis and Takayasu arteritis, are linked to thoracic aortic aneurysms
  • untreated infection - in rare cases, it's possible to develop a thoracic aortic aneurysm if you've had an infection, such as syphilis or salmonella and it’s left untreated
  • traumatic injury - rarely, some people can develop thoracic aortic aneurysms after an injury due to a fall or motor vehicle crash.   

How is a thoracic aortic aneurysm diagnosed?

Thoracic aortic aneurysms are often found when a test is done for something else.

Tests may include:  

Aortic conditions can be inherited, so if you have a family history of aortic aneurysm you should speak to your doctor about screening for you and your family. It’s important to get the right diagnosis, treatment and support from specialists. 

Genetic testing is available for aortic conditions, including thoracic aortic aneurysm. It’s recommended this is carried out in an Inherited Cardiac Clinic where there are specialist nurses, doctors, geneticists and genetic counsellors.   

You can talk to one of our expert cardiac nurses about screening and genetic testing for you and your family through our Genetic Information Service.

How is a thoracic aortic aneurysm treated?

Treatment of a thoracic aortic aneurysm varies from regular health checks to emergency surgery. The type of treatment depends on the cause, size, location and growth rate of the thoracic aortic aneurysm. Your doctor will talk to you about the best option for you.  

If you have been diagnosed with a thoracic aneurysm, it is likely that you’ll be monitored with echocardiograms and CT scans every six or 12 months, to see if there are signs of changes in your aneurysm. How fast the aneurysm grows (if at all) will be different for everyone. 

Medicines may be prescribed to control risk factors such as high blood pressure and high cholesterol. These may include: 

Other treatments include:

  • Endovascular aortic aneurysm repair (EVAR). This involves tubes called stents put into your arteries to let blood flow freely.  
  • Your surgeon may recommend heart surgery (if your thoracic aneurysm has grown too much, causes symptoms, or if you have Marfan syndrome.) This involves removing the section of the aorta where the aneurysm is and replacing it with a new aorta made of synthetic (man-made) material, called a graft. 
  • Personalised external aortic root support (PEARS). This procedure can be offered to people with Marfan syndrome where the bottom of the aorta is very big. A special sleeve is made to put around the aorta to stop it getting bigger. 

If you need surgery to repair your thoracic aortic aneurysm you will be seen in a special clinic. At the clinic, you may need to have some routine tests such as X-rays and blood tests. You’ll have the opportunity to ask questions about the surgery and your after care. Write your questions down before you attend so you remember what to ask. 

Depending on the type of surgery you have, most people will recover well and return to their normal life. Your healthcare professional will talk you through what’s expected during your recovery such as your exercise plan and when you can go back to work. 

Life after a diagnosis of thoracic aortic aneurysm or surgery 

Most people can still live a normal life after a diagnosis of thoracic aortic aneurysm. You may need to have regular tests and your doctor may tell you to avoid heavy lifting and some physical activities. These can increase your blood pressure, putting additional strain on your aneurysm. Speak to your doctor or specialist nurse if you have questions about your lifestyle and exercise.  

What puts me at risk of getting a thoracic aortic aneurysm?

Thoracic aortic aneurysm risk factors include: 

  • smoking  
  • high blood pressure 
  • family history 
  • age - getting older increases the risk of aortic aneurysms. Thoracic aortic aneurysms occur most often in people aged 65 and older
  • genetic conditions such as Marfan syndrome, Loeys-Dietz syndrome or vascular Ehlers-Danlos syndrome.

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Page last reviewed: June 2024
Next review due: June 2027

For more information

Call our BHF Genetic Information Service to speak to one of our specialist nurses for information about inherited heart conditions and how they can affect you and your family.

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