Thoracic Aortic Aneurysm - A Dilatation Closed to the Heart

After discussing abdominal aortic aneurysm in my previous post, I would like to tackle and give some information regarding another dilatation in another part of the aorta, the thoracic aorta.

The thoracic aorta lies between the heart and the diaphragm and gives rise to the brachiocephalic, left common carotid. left subclavian, bronchial, esophageal and intercostal arteries. Thoracic aortic aneurysms are caused by cystic medial necrosis, atherosclerosis or less commonly by trauma, dissection or infection. Males are affected 3 times as often as females and factors include atherosclerosis, smoking, hypertension and family history.

Most aneurysms are asymptomatic. Rupture usually presents with chest pain or pressure. Expansion of the aneurysm can compress its surrounding structures like the trachea and the bronchus. Hypotension and tachycardia may be present and could also present with the triad of shock, distant heart sounds and distended neck veins.

As with abdominal aortic aneurysms, surgical management should be considered in aneurysms with a large diameter. Symptomatic presentation in an indication for immediate surgical intervention.

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Abdominal Aortic Aneurysm - a Dilated Abdominal Aorta

An aneurysm is an abnormal dilatation of an artery. The serious nature of arterial aneurysms relates to the weakened vessel wall and potential for rupture or vascular compromise.

An abdominal aortic aneurysm is a dilatation of the abdominal aorta which lies between the diaphragm and above the iliac arteries. Its branches include the celiac trunk, superior mesenteric artery, inferior mesenteric artery, renal arteries and gonodal arteries. Most aneurysms usually occur at the distal part located near the renal arteries.

95% of aneurysms of the abdominal aorta are due to atherosclerosis, other causes include trauma, infection, syphilis and Marfan's syndrome. Men are affected 10 times more frequently than women with an age of onset usually between 50 to 70. Most of them are asymptomatic. Pain usually signifies a change ion the aneurysm, commonly enlargement, rupture or compromise of vascular supply and should therefore be considered an ominous symptom.

Any patient presenting with symptoms on physical examination suggesting a catastrophic aortic even should undergo emergent diagnostic evaluation and workup. Treatment of asymptomatic abdominal aortic aneurysms depends on the size of the lesion, usually medical for smaller lesions and surgical for bigger lesions which are usually at a higher risk of rupturing.

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Inguinal Hernia - Weakness in the Inguinal Floor

A hernia occurs when a defect or weakness in a muscular or fascial layer allows tissue to abnormally protrude. Between 500,000 to 1,000,000 hernia repairs are performed every year and half of all of them are inguinal hernias. In decreasing incidence are incisional and ventral, femoral and umbilical. Indirect inguinal hernias are the most common in both males and females with a 5:1 male predominance.

Hernias are categorized as reducible, incarcerated or strangulated. Reducible hernias can be returned to their body cavity of origin, incarcerated hernias cannot be returned to their body cavity of origin while strangulated hernias contain a tissue with a compromise vascular supply.

Patients with reducible inguinal hernias describe an intermittent bulge in the groin or scrotum. Persistence of the bulge or nausea or vomiting raises concern for incarceration. Severe pain at the hernia site or in the abdomen with nausea and vomiting, may occur in strangulation.

Treatment for hernias are usually surgical in nature. Reducible hernias should be repaired on an elective basis. An incarcerated hernia should be operated on urgently whereas a strangulated hernia is a surgical emergency.

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