Aortic Aneurysm (thoracic, abdominal)
Aneurysms are described as an abnormal dilation in the wall of a blood vessel due to a rupture/weakening of the intima. Thoracic aneurysms are the most common form of dissecting aneurysms and result from trauma, congenital vascular disease, infection, or atherosclerosis.
Demographics:
- 95% of aortic aneurysms occur below the renal arteries.
- Primary risk factors include males, age 40-70 years, hypertension, history of congenital heart disease, atherosclerosis or CAD, or recent infection.
- Secondary risk factors include patients who have undergone thoracic or abdominal surgery or those on anti-coagulant therapy (Booher and Eagle 2011).
Clinical Presentation:
- While most aortic aneurysms are asymptomatic, the most common symptoms are a pulsing feeling in the abdomen and back pain at the thoraco-lumbar junction.
- Pain may also refer to the chest, neck, shoulders, between the scapulae, anywhere in the back (including sacrum) or the posterior thigh and be described as sharp/severe/intense/knifelike.
- Pain not relieved by change of position
- Cold LE, dimished LE pulses
- Systolic BP <100
- >10mmHg change in Diastolic BP between arms
- Lightheadedness and nausea (Booher and Eagle 2011).
Differential Diagnosis:
- Pain/symptoms that cannot be changed by movements/positional changes should alert the therapist that the condition may not be musculoskeletal in origin.
- Palpation of the abdominal aorta should be performed to assess for presence of abdominal pulsating mass (Booher and Eagle 2011).
Bottom Line: treat and refer
- Patients with an obvious, large pulsating abdominal mass should be referred out immediately
- Patients with neck, shoulder, chest, posterior thigh, upper or lower back and/or abdominal pain that is unchanged by position or movement should be referred, although conservative treatment is reasonable assuming their vital signs are stable and monitored closely.
- Note: It is important to teach patients with aortic aneurysms/suspected aortic aneurysms how to avoid using the valsalva maneuver when exercising, using the restroom, or performing ADLs (Booher and Eagle 2011).
References:
Please refer to the "Aortic Aneurysm" section of the reference list.