Aortic aneurysm

Aortic aneurysm (aneurysma aortae) - limited expansion of the lumen of the aorta caused by protrusion changed its walls. The main causes of A. A. are aortic, mainly syphilis, and atherosclerosis of the aorta.
Much less frequently A. A. is the result of trauma or congenital dislocations of the aortic wall. Note the decrease in the frequency of aortic aneurysms are associated with a decrease the number of patients with A. A. syphilis origin.
Aortic aneurysm more common in men. Localized aneurysm in the vast majority of cases in the thoracic aorta.
Aneurysms of the thoracic aorta, especially its ascending part, usually syphilis etiology, aortic aneurysm - atherosclerotic. Often form one aneurysm, but there can be two or more. Largest aortic aneurysm varies from very small, barely noticeable, to large, squeeze the adjacent organs and vypyachivalis outside of the chest. Prescription A. A. usually difficult, as it is unknown how long aortic and when the first signs of the aneurysm.
Pathologic anatomy - see Aneurysm.
The clinical picture of aortic aneurysms depends on its location, size, shape and direction of growth. However, in some cases even the significant A. A. can be asymptomatic and identified by accident with radiological examination or autopsy.
Aneurysm of the first segment of the ascending aorta aneurysm or sinuses Valsalva, occurs most often. When a large aneurysm this can compress adjacent pulmonary artery, right atrium, the upper Vena cava with the development of stagnation above designated compression. In some cases breakout occurs aneurysm sinuses Valsalva in the right half of the heart. This is accompanied by the appearance of chest pain, intense noise, listening throughout systole and diastole, symptoms of stress and the failure of the right ventricle.
Aneurysm of the ascending aorta occurs more often. Patients usually experience a dull pressure prolonged pain in the upper chest. Most often, this aneurysm is distributed to the front and with significant value forms a protrusion of the thorax area in the form of a pulsating "tumor" (Fig. 1). Typical systolic jitter and noise at the handle of the sternum and in the II-III intercostal space on the edges of the sternum, it is Often stated failure aortic valves with diastolic noise of the aorta, which is expressed by the pulsation of the carotid artery, the increase in pulse pressure, capillary pulse etc. (Fig. 2; spirogramma carotid artery - the fast rise of the curve, no cut-and discretional waves; on the soundtrack - prettiesiski noise).

Fig. 1. "Tumor" in the upper part of the sternum in patients with aneurysm of the ascending aorta.

Fig. 2. Syphilis aneurysm of the ascending aorta and the aortic valve insufficiency: 1 - ECG I lead; 2 - spirogramma right carotid artery; 3 - spirogramma right radial artery; 4 - FCG the apex of the heart.

Occasionally aneurysm of the ascending aorta squeezes top Vena cava and lymphatic vessels of the chest cavity.
Aneurysm of the aorta arch is less common than aneurysm of the ascending part of it. It is mainly characterized by symptoms of compression of the trachea, left bronchus, recurrent nerve, cervical sympathetic nodes, nearby vessels. The compression of the trachea can cause painful cough, stredoceskeho breathing, significant respiratory failure. In case of compression of the left bronchus may occur full or partial left lung atelectasis. Often due to compression return nerve paralysis develops left vocal chords with the weakening of voice and even with full aphonia. Compression of one of the subclavian arteries can lead to a weakening of the heart rate and lowering of blood pressure, respectively, on the right or left hand.
Descending aorta aneurysm occurs much less frequently than aneurysm its ascending parts and arcs, and is characterized by symptoms compression of the left lung, esophagus, vertebral bodies and nerve roots. Patients are suffering a painful radicular pain. Often there are destruction of the bodies of the vertebrae and ribs, dysphagia, pneumonia, recurrent hemoptysis due to pressure in the pulmonary tissue.
Abdominal aneurysm usually determined by the presence throbbing tumor in the left side of the upper abdomen, which can be defined systolic jitter and noise. Patients are suffering pain in the abdomen, frequent violations mocheotdelenia, and the passage of food through the intestine. Most frequent and severe complications A. A.- acute or subacute developing thrombosis and break the wall of the aorta. Thrombosis occurs full or partial obstruction located in aneurysmal bag of aortic branches. The wall rupture of the aneurysm is usually quickly leads to death from blood loss.
Diagnosis in the early stages of A. A. difficult, because the clinical presentation in this period weak or absent. The most important data can be obtained by x-ray (see below X-ray analysis). Diagnostic value have a positive reaction Wasserman, anamnesticescimi indications syphilis, expressed signs of atherosclerosis, etc., Some of the signs-like symptoms A. A., can be observed in tumors and cysts of the mediastinum (see) and the abdominal cavity, increasing lymph nodes of the chest and abdomen, when matecznego (see Matecznik), and in severe ripple abdominal aorta in malnourished and astenikiv.
The prognosis for A. A. depends on the activity of the process that caused it, the size, location of the aneurysm, complications. The compression of the vital organs, development of heart failure, thrombosis and embolism, breaks the wall of the aorta in the short term lead patients to disability and death.
Prevention A. A. is timely and complete treatment of syphilis (see), atherosclerosis (see) and other diseases that can cause A. a. To prevent complications, it is important timely surgical treatment.
Treatment A. A.- surgical (see below Surgical treatment). When syphilis A. A. even in the later stages of the required active specific therapy. Commonly prescribed drugs bismuth (biogenol), mercury and iodine preparations, penicillin.
With circulatory failure and symptoms of angina pectoris (see) - symptomatic treatment.