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Symptoms and Signs of Aortic Aneurysm of the Abdomen and Thorax (Chest)

Doctor's Notes on Aortic Aneurysm

An aortic aneurysm is an outpouching or bulging of the aorta, which is the largest artery in the human body. Arteries carry blood away from the heart to other parts of the body. Arteriosclerosis is the most common cause of an aortic aneurysm, and smoking is a major risk factor for their development.

An aortic aneurysm may not produce symptoms or signs unless it ruptures. Signs and symptoms can include deep pain in the lower back or flank and abdominal pulsations. Rupture of an aortic aneurysm is a serious emergency. Sudden and severe pain is the most common symptom of a ruptured aortic aneurysm. A ruptured aortic aneurysm causes massive internal bleeding and can be fatal.

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Medically Reviewed on 3/25/2019

Aortic Aneurysm Symptoms

Aneurysms usually do not cause any symptoms until they become very large or rupture. Aneurysms in the abdominal aorta are often found coincidentally when the individual undergoes a medical test or procedure for some other reason.

Chest pain and back pain are the two most common symptoms of large aneurysms.

  • Almost any unusual sensation or feeling in the upper chest or back, however, may be due to an aneurysm of the aorta.
  • Chest pain is usually the first sign of aortic dissection. Many people describe a tearing or ripping pain in the chest when the aorta enlarges to a critical size and ruptures/dissects. Besides pain, increased sweating, a fast heart rate, rapid breathing, dizziness, and shock may occur.

Some people describe the following symptoms of an aortic aneurysm:

  • A pulsating bulge or a strong pulse in the abdomen
  • Feeling of fullness after minimal food intake
  • Nausea
  • Vomiting

Where the aorta widens into a bulge, blood clots (thrombi) are more likely to form. If a piece of a blood clot breaks off, it travels through the circulatory system until it lodges somewhere. The clot can cut off blood flow to any area of the body. Symptoms depend on which part of the body is deprived of blood.

  • In the most serious cases, the broken off fragments can cause stroke or heart attack. The fragments can also cause one or more vital body organs, such as the lungs, liver, or kidneys, to stop functioning properly.
  • In less serious cases, it might cause numbness, weakness, tingling, pallor, or coldness in an arm or leg, loss of sensation, light-headedness, or localized pain.

Any of these symptoms can also occur with dissection of the aorta. The pain in the chest or pain may be particularly severe, and may mimic a heart attack.

In ruptured aneurysm or dissection, internal bleeding will occur. If a person has any of these symptoms along with the other symptoms of aortic aneurysm, they could be in danger and must seek emergency medical care right away. Other symptoms include the following:

These symptoms are not unique to people that have aortic aneurysms but they do indicate the person is likely experiencing a medical emergency that could include an aortic aneurysm. A major reason for most of the above symptoms is loss of blood from the leaking aneurysm. If the bleeding is uncontrolled, the person's blood pressure will drop dangerously low. Organs will not receive enough blood to function normally. This is called circulatory collapse, or just "shock."

  • This is a life-threatening condition.
  • People lose consciousness if their brain does not receive enough blood; they then may be at risk of death if the bleeding continues.
  • Other organs may start to fail.
  • The heart can stop beating. This is called cardiac arrest and is often fatal.

Aortic Aneurysm Causes

An aortic aneurysm develops from a weakness in the wall of the aorta. This weakness can be present at birth or can develop as the result of disease or injury.

  • Atherosclerosis: A clogged or damaged artery from a condition called atherosclerosis is the most common cause of aneurysm. Atherosclerosis is often called hardening of the arteries because it calcifies later in life. In atherosclerosis, a fatty substance (cholesterol) called plaque sticks to the lining of the blood vessel wall, weakening the wall. Atherosclerosis is also the most common cause of heart disease and heart attack.
  • High blood pressure: High blood pressure puts stress on the wall of the aorta. Over many years, this stress can lead to bulging of the blood vessel wall. This is the leading factor in development of aneurysms of the thoracic aorta.
  • Diabetes: Uncontrolled diabetes damages blood vessels by premature, accelerated atherosclerosis, leaving them vulnerable to a number of conditions including aneurysm formation.
  • Cystic medial necrosis: In this condition, the medial layer of the blood vessel wall degenerates, and an abnormal fibrous layer weakens the supporting structure of the blood vessel wall itself. This commonly occurs with certain rare inherited conditions such as Marfan syndrome and Ehlers-Danlos syndrome. It also occurs with heart valve disease and pregnancy.
  • Mycotic aneurysm occurs when bacteria spread into the arterial system, invade the blood vessel wall, and weaken the vessel. Often the bacteria enter areas of previous damage or areas weakened since birth. Although rare today, the advanced form of the sexually transmitted disease (STD) syphilis was a common cause of this condition in the early part of the 20th century.
  • Inflammatory aneurysm: Inflammatory conditions or vasculitis, such as psoriasis and rheumatoid arthritis, may produce inflammation in the blood vessel wall itself. If the inflammation is not reversed, it eventually weakens the wall of the aorta. Vasculitis generally affects the smaller to medium-sized vessels and rarely the aorta.
  • Injury: Injury to the chest or abdomen, as in a car wreck or bad fall, can damage an area of the aorta. This leaves the aorta vulnerable to bulging.

In many cases, the cause of an aortic aneurysm is never known.

Risk factors for aortic aneurysm include the following:

  • Age 55 years or older
  • Male sex
  • High blood pressure
  • Smoking
  • Inherited diseases that cause weakening of the blood vessels, with emphasis on Marfan syndrome
  • Family history of aortic aneurysm
  • Hardening of the arteries (atherosclerosis)

What's Causing Your Abdominal Pain? Slideshow

What's Causing Your Abdominal Pain? Slideshow

The abdomen is an anatomical area that is bounded by the lower margin of the ribs and diaphragm above, the pelvic bone (pubic ramus) below, and the flanks on each side. Although abdominal pain can arise from the tissues of the abdominal wall that surround the abdominal cavity (such as the skin and abdominal wall muscles), the term abdominal pain generally is used to describe pain originating from organs within the abdominal cavity. Organs of the abdomen include the stomach, small intestine, colon, liver, gallbladder, spleen, and pancreas. Abdominal pain can range in intensity from a mild stomach ache to severe acute pain. The pain is often nonspecific and can be caused by a variety of conditions.


Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.