A thoracic aortic aneurysm is often discovered incidentally during an imaging study done for other reasons. Your doctor may first suspect you have a thoracic aortic aneurysm by looking at a chest X-ray
If your doctor thinks you might have an aortic aneurysm, you will likely have a medical history and physical exam. You will then have further imaging tests to locate the aneurysm and estimate its size:
Computed Tomography Angiography (CTA):
CTA is the most accurate study for the diagnosis of a thoracic aortic aneurysm, at the cost though of the need for radiation and intravenous dye (iodinated contrast) that may be harmful for the kidneys, especially in patients with impaired renal function.
Your vascular surgeon will request this study to gather detailed information on the specific anatomy of the aneurysm and its relation to the heart, the brain and arm arteries.
This information is particularly important for preoperative planning.
Magnetic Resonance Angiography (MRA):
MRA can be as accurate as the CTA, doesn’t require radiation and if intravenous contrast is used (gadolinium) it is less harmful for the kidneys. Drawbacks are that it may be time consuming, it is expensive and it may be contraindicated in patients with claustrophobia or metallic implants.
Echocardiogram:
The Echocardiogram uses sound waves to capture real-time images of your heart and the ascending aorta.
The echocardiogram shows how well your heart is working.
Thoracic aortic aneurysms may be seen by the echocardiogram, and this technique is often used to screen family members of those with thoracic aortic aneurysm.
Occasionally, to better see your aorta, particularly its descending part, your doctor may recommend transesophageal echocardiogram.
While the “transthoracic” echocardiogram is relatively simple and non-invasive, the transesophageal echocardiogram requires some twilight anesthesia as the device is threaded down your esophagus.
Traditional Angiography:
It is an invasive imaging study done in a surgical environment as it requires arterial access through a groin puncture.
It requires radiation and intravenous contrast and it may be used to assist your vascular surgeon’s operative plan.
In contemporary practice, it is not routinely recommended for diagnosis.
It will eventually be used as part of your treatment if an endovascular repair has been decided.