Thoracic Aortic Aneurysm: Causes, Symptoms, and Treatment
Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Thoracic Aortic Aneurysm?
A cardiologist, a heart doctor, usually follows this condition over time. A heart and chest surgeon repairs larger ones. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is a thoracic aortic aneurysm?
An aneurysm is an abnormal ballooning of part of an artery. It happens because the blood vessel wall is weak. The aorta is the body's largest artery. A thoracic aortic aneurysm happens where it passes through the chest.
The aorta has three parts. The first part goes up toward the head. It is the ascending aorta. The middle part is curved. It is the aortic arch. The last part goes down toward the feet. It is the descending aorta.
Aneurysms develop slowly over many years. An aneurysm in the belly part of the aorta happens more often than one in the chest.
Symptoms
Most people have no symptoms until the aneurysm begins to leak or expand. Symptoms often begin suddenly. This can happen if the aneurysm grows quickly, tears open (a rupture), or leaks blood along the aortic wall (a dissection).
If the aneurysm presses on nearby parts of the body, these symptoms may occur:
- Hoarseness.
- Swallowing problems.
- High-pitched breathing called stridor.
- Swelling in the neck.
Other symptoms may include:
- Chest or upper back pain.
- Shortness of breath.
- Clammy skin.
- Nausea and vomiting.
- A sense of impending doom.
Causes and who gets it
The most common cause is atherosclerosis, which is hardening of the arteries. It is more common in people with high cholesterol, long-term high blood pressure, or who smoke.
Other risk factors include:
- Changes caused by age.
- Connective tissue diseases such as Marfan or Ehlers-Danlos syndrome, which affect the body's supporting tissue.
- Inflammation of the aorta.
- Injury from falls or motor vehicle accidents.
- Syphilis, an infection.
- A family history of aneurysms.
How doctors diagnose it
Most thoracic aortic aneurysms are found on imaging tests done for other reasons. They include a chest x-ray, an echocardiogram (a heart ultrasound), a chest CT scan, or an MRI. A chest CT scan shows the size of the aorta and the exact location of the aneurysm.
The physical exam is often normal unless a rupture or leak has occurred. Your provider may recommend screening if you have a close relative with a thoracic aortic aneurysm. Screening may also be advised for some genetic conditions, such as Marfan, Ehlers-Danlos, Loeys-Dietz, or Turner syndrome.
Treatment
Treatment depends on the size of the aneurysm and how fast it is growing. Small aneurysms are often watched with regular imaging tests. They may also be treated with medicines for blood pressure and cholesterol. Large or fast-growing aneurysms often need surgery to lower the risk of rupture.
For the ascending aorta or aortic arch, doctors recommend surgery if the aneurysm is over 5 to 6 centimeters (about 2 inches). The aorta is replaced with a plastic or fabric graft, which is a tube that takes its place. This is major surgery that uses a heart-lung machine.
For the descending aorta, major surgery is done if the aneurysm is larger than 6 centimeters (2.3 inches). A less invasive option is endovascular stenting. A stent is a tiny tube placed without cutting the chest. However, not all people with descending thoracic aneurysms are candidates for stenting.
Serious problems after aortic surgery can include bleeding, infection of the graft, heart attack, irregular heartbeat, kidney damage, paralysis, and stroke. Death soon after the operation occurs in 5% to 10% of people.
When to see a doctor
Contact your health care provider if you have chest or back discomfort. Also call if you have a family history of connective tissue disorders such as Marfan or Ehlers-Danlos syndrome.
A ruptured aortic aneurysm can cause sudden, severe internal bleeding and is a medical emergency. Call 911 right away if you have sudden, severe pain in your chest or back. Also call for dizziness or a fast heartbeat.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Such a doctor can help you control blood pressure and cholesterol, which lowers risk. They can also talk with you about smoking, diet, and exercise. They can help coordinate care with heart specialists.
Common questions
What causes a thoracic aortic aneurysm?
The most common cause is atherosclerosis, which is hardening of the arteries. Other causes include connective tissue diseases, injury, inflammation of the aorta, and syphilis.
Does a thoracic aortic aneurysm always need surgery?
No, small aneurysms are often watched with regular imaging tests. They may also be treated with medicines for blood pressure and cholesterol. Large or fast-growing aneurysms often need surgery.
Can a thoracic aortic aneurysm be prevented?
You may not be able to prevent it, but you can lower your risk. Do not smoke. Manage your blood pressure and cholesterol, eat a heart-healthy diet, and stay active.
What is the difference between a thoracic and an abdominal aortic aneurysm?
A thoracic aneurysm is in the chest part of the aorta. An abdominal one is in the belly part. Abdominal aortic aneurysms happen more often than thoracic ones.
Sources
- MedlinePlus - Thoracic aortic aneurysm
- MedlinePlus - Aortic Aneurysm
- Centers for Disease Control and Prevention - About Aortic Aneurysm
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
