Aortic root dilatation is suspected in adult men when the aortic diameter is above 40 mm and in women above 36 mm. Causes: hypertension, Marfan syndrome, syphilis.

Clinical presentation

• Shortness of breath, awareness of the heartbeat, hoarse voice.

Investigations

• Chest X-ray: widened mediastinum.

• Echocardiogram: ascending aortic root and arch.

• CT aortogram: the definitive test.

Management

• Consult a specialist and refer to a high-level specialised hospital.

• Abdominal aortic aneurysms are repaired surgically when ruptured, symptomatic or large enough; recommend elective repair for patients at acceptable surgical risk with a fusiform AAA of 5.5 cm or more in men and above 5 cm in women.

• Ruptured AAA needs emergency repair: open repair (transperitoneal or retroperitoneal) or endovascular repair (stent graft placed through the femoral vessels, extending into the iliac arteries).