History: Symptoms vary depending on the location and size of the aneurysm, whether rupture has occurred, and whether there are associated effects due to increased pressure or blood leaking into surrounding organs and tissue. An individual with a thoracic aortic aneurysm may complain of sudden severe chest pain, shortness of breath, fainting, pallor, sweating, a bluish tinge around the mouth and on the nail beds (cyanosis), increased pulse rate, leg weakness, or transient paralysis. Individuals may also experience difficulty breathing, a harsh cough, or wheezing. Compression of the esophagus may cause hoarseness or loss of voice.
With an abdominal aortic aneurysm, individuals may be without symptoms (asymptomatic) and unaware of the condition. Some individuals may complain of an abnormal, pulsating feeling in the abdomen. Constant pain in the lower back region as a result of pressure on the lumbar nerves may be present.
Individuals experiencing severe, persistent chest, back, or abdominal pain may have an aneurysm that has already ruptured. Additional symptoms indicating that rupture has occurred include low blood pressure, weakness, sweating, anxiety, excessive thirst, a fast heart rate (tachycardia), nausea and vomiting, lightheadedness, fainting, dry skin or mouth, or an abdominal mass.
Physical exam: With a thoracic aortic aneurysm, the physician may note an increased pulse rate or a bluish tinge around the mouth and fingernails (cyanosis). Listening to the heart with a stethoscope (auscultation) may reveal an abnormal sound between beats when the heart is at rest (diastolic murmur). An abrupt loss of the pulse at the wrist (radial) and the pulse inside the upper thigh (femoral), or wide variations in pulses or blood pressure between the arms and legs may be noted. The individual may appear to be in shock, which is usually associated with low blood pressure, but the upper number of the blood pressure (systolic) is normal or even elevated.
With an abdominal aortic aneurysm in non-obese individuals, a pulsating mass may be felt when applying light pressure with the fingertips (palpation). Swelling around the navel (umbilicus) may be evident. A soft, blowing sound (bruit) may be heard when through a stethoscope placed over the aneurysm (auscultation). This condition rarely causes a diminished peripheral pulse.
Tests: Thoracic aortic aneurysms may be diagnosed incidentally when a chest x-ray is ordered for an unrelated reason. Electrocardiography (ECG) and echocardiography may help identify a dissecting aneurysm of the aortic root.
Ultrasound can determine the size and extent of an abdominal aneurysm. It is a noninvasive, cost-effective test that is nearly 100% accurate. Other tests may include CT or magnetic resonance imaging (MRI). If there is concern that the aneurysm is located above the renal arteries, which occurs in approximately 10% of cases, aortography may be done. In this procedure, contrast medium is inserted into a blood vessel through the arm or leg, and the flow of the medium is monitored on x-ray, revealing the precise size and location of the aneurysm.
In a study of 198 individuals with abdominal aortic aneurysms, 48% were discovered by history and physical examination, 37% during an imaging or x-ray procedure, and 15% at surgery (laparotomy). Of those detected during an imaging or x-ray procedure, subsequent examination showed that 38% could be felt (palpated) in the abdomen, although the aneurysm had been missed on initial examination. Thorough clinical examination is therefore extremely important in diagnosing this condition.
Blood tests may show decreased hemoglobin levels that indicate blood loss from a leaking or ruptured aneurysm, although in the setting of an acute rupture, the blood tests may not show any change.