Clin. Radiol. (1975) 26, 475-482
LOCALISED
ANEURYSMS
OF T H E D E S C E N D I N G
THORACIC AORTA
CHARLES B. HIGGINS,* N O R M A N R. SILVERMAN, R O N A L D D. HARRIS and K E N N E T H W. ALBERTSON
From the Department of Radiology, UniversiO, of California, San Diego, La Jolla, California 92037 The clinical, roentgenographic and aortographic data were reviewed in 12 patients with localised descending, thoracic aortic aneurysms. The current study indicates that arteriosclerotic peripheral vascular disease not infrequently produced localised saccular aneurysms of the descending thoracic aorta. Characteristic symptomatology was unusual; most aneurysms were detected as incidental roentgenographic findings. The aneurysms projected from the posteroloteral aspect of the aorta and roentgenographically appeared as left hilar masses or left retrocardiac masses when located in the mid and lower descending thoracic aorta, respectively. Specific rim calcification or vertebral erosion was not encountered in any case. During aortography only a small portion of the aneurysm was outlined with contrast material due to partial obliteration of the aneurysmal cavity with thrombus.
THORACIC aortic aneurysms have in the past been believed to be most frequently luetic in origin and located in the ascending aorta (Brindley and Stembridge, 1956; Cranley et aL, 1954; Kampmeier, 1938; Levene et al., 1954; Maniglia and Gregory, 1952). However, more recent studies indicate that arteriosclerosis is now the most prevalent aetiologic factor (Fomon et al., 1967; Joyce et al., 1964). Arteriosclerotic aneurysms are usually fusiform, diffuse, and situated distal to the ascending aorta (Fomon et al., 1967; Joyce et aL, 1964; Levene et
al., 1954; Steinberg, 1957). Arteriosclerotic aneurysms are not infrequently located in the descending portion of a generally ectatic thoracic aorta where they have a characteristic roentgenographic appearance (Steinberg, 1957; Steinberg and Halpern, 1964). Localised aneurysms in the descending aorta are much less common (Joyce et al., 1964; Maniglia and Gregory, 1952). Since the diagnostic features of these relatively uncommon aneurysms have received little attention in the literature, the current study portrays the salient
TABLE 1 ROENTGENOGRAPHIC FEATURES OF LOCALISED DESCENDING THORACIC AORTIC ANEURYSMS Hilar mass
Retrocardiae mass
R
L
R
L
Cardiomegaly
Calcification
Skeletal erosion
Mid thoracic
0
3
0
0
2
1
0
Distal thoracic
0
0
0
7
2
1
0
Combined
0
2
0
0
2
1
0
Nttmber
* Present address: Department of Radiology, Stanford University Hospital, Palo Alto, California 94305. 47S
476
CLINICAL
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RADIO
LOGY
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LOCALISED
ANEURYSMS
OF T H E D E S C E N D I N G
THORACIC AORTA
CHARLES B. HIGGINS,* N O R M A N R. SILVERMAN, R O N A L D D. HARRIS and K E N N E T H W. ALBERTSON
From the Department of Radiology, UniversiO, of California, San Diego, La Jolla, California 92037 The clinical, roentgenographic and aortographic data were reviewed in 12 patients with localised descending, thoracic aortic aneurysms. The current study indicates that arteriosclerotic peripheral vascular disease not infrequently produced localised saccular aneurysms of the descending thoracic aorta. Characteristic symptomatology was unusual; most aneurysms were detected as incidental roentgenographic findings. The aneurysms projected from the posteroloteral aspect of the aorta and roentgenographically appeared as left hilar masses or left retrocardiac masses when located in the mid and lower descending thoracic aorta, respectively. Specific rim calcification or vertebral erosion was not encountered in any case. During aortography only a small portion of the aneurysm was outlined with contrast material due to partial obliteration of the aneurysmal cavity with thrombus.
THORACIC aortic aneurysms have in the past been believed to be most frequently luetic in origin and located in the ascending aorta (Brindley and Stembridge, 1956; Cranley et aL, 1954; Kampmeier, 1938; Levene et al., 1954; Maniglia and Gregory, 1952). However, more recent studies indicate that arteriosclerosis is now the most prevalent aetiologic factor (Fomon et al., 1967; Joyce et al., 1964). Arteriosclerotic aneurysms are usually fusiform, diffuse, and situated distal to the ascending aorta (Fomon et al., 1967; Joyce et aL, 1964; Levene et
al., 1954; Steinberg, 1957). Arteriosclerotic aneurysms are not infrequently located in the descending portion of a generally ectatic thoracic aorta where they have a characteristic roentgenographic appearance (Steinberg, 1957; Steinberg and Halpern, 1964). Localised aneurysms in the descending aorta are much less common (Joyce et al., 1964; Maniglia and Gregory, 1952). Since the diagnostic features of these relatively uncommon aneurysms have received little attention in the literature, the current study portrays the salient
TABLE 1 ROENTGENOGRAPHIC FEATURES OF LOCALISED DESCENDING THORACIC AORTIC ANEURYSMS Hilar mass
Retrocardiae mass
R
L
R
L
Cardiomegaly
Calcification
Skeletal erosion
Mid thoracic
0
3
0
0
2
1
0
Distal thoracic
0
0
0
7
2
1
0
Combined
0
2
0
0
2
1
0
Nttmber
* Present address: Department of Radiology, Stanford University Hospital, Palo Alto, California 94305. 47S
476
CLINICAL
< [-
RADIO
LOGY
I
,¢
