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.