Surgical repair of thoracic aortic aneurysms is generally dictated by size. Aneurysms need repair to prevent rupture. Anything over 6 cm (which is the magic number , according to authorities) will make almost all cardiothoracic surgeons anxious. -For non-marfans patients Most cardiac surgeons will use a cut off for surgery of: ascending aorta > 5.5 cm and descending aorta > 6.5 cm -Patients with Marfans: Threshold to operate is a bit lower. ascending >5 cm and descending > 6 cm So, who cares, you ask? #1-We scan a lot of chests and we will be diagnosing this in the ED. #2-As emergency physicians we should have some familiarity with the aortic size that makes Cardiothoracic surgeons nervous and the size that can get outpatient followup. Calling a CT surgeon to the ED to see a patient with an incidental 4.8 cm ascending aortic aneurysm in many cases is not necessary...depends on the patient, followup, etc. They will definitely not be excited about a 4.8 cm aneurysm. Sure, it looks HUGE on CT, but most won't operate on this size.
