Certain types of aortic aneurysms have no symptoms unless they rupture, while others can cause pain or discomfort in the chest, abdomen, back, and elsewhere.

An aortic aneurysm is an abnormal bulge in the aorta, your body’s largest blood vessel. The aorta stretches from the heart down to the tops of your legs. It feeds blood to a complex network of arteries that nourish your body’s organs, muscles, and other tissues.

While males are more likely than females to develop an aortic aneurysm, the health risks and complications facing females with aortic aneurysms can be more severe.

Symptoms vary depending on the aneurysm’s size and location and whether the aneurysm remains stable or ruptures.

A ruptured aortic aneurysm is a life threatening medical emergency. If you receive an aneurysm diagnosis, medical monitoring, symptom awareness, and sometimes treatment is necessary.

Language matters

In this article, we talk about aortic aneurysms in people assigned female at birth. It’s important to note that not everyone assigned female at birth identifies with the label “female.” However, at times we use “male” or “female” to reflect the language in a study or statistic or to make sure people can find this article with the terms they search.

When possible, we aim to be inclusive and create content that reflects the diversity of our readers.

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Aortic aneurysm symptoms differ depending on where the aneurysm has formed along the aorta. However, an aortic aneurysm, regardless of its location, may have no symptoms at all.

Abdominal aortic aneurysms may have some of the following symptoms:

  • abdominal pain that doesn’t subside
  • back pain that doesn’t subside
  • pulsating sensation behind the belly button, though it may only be felt when gently pressing on the abdomen

Generally, only larger abdominal aortic aneurysms have symptoms. However, a 2020 report suggests that females are more likely than males to have an abdominal aortic aneurysm rupture when the aneurysm is much smaller.

This means the risk of a potentially dangerous aneurysm being missed is often higher among females.

A ruptured abdominal aortic aneurysm usually triggers a sudden, sharp pain in your abdomen or on one side.

Thoracic aortic aneurysms may cause chest or back pain. And, if the aneurysm pushes against the esophagus, you may experience difficulty swallowing.

An aneurysm that pushes against your windpipe (trachea) or lungs might make breathing more difficult. A thoracic aortic aneurysm can sometimes cause hoarseness.

A ruptured thoracic aortic aneurysm causes sudden and severe chest pain as well as a sudden and significant drop in blood pressure.

If you suspect an aortic aneurysm

Because aortic aneurysms often develop without obvious symptoms, you may not know or suspect you have one until it’s detected during an unrelated exam or if it ruptures.

If you have unexplained pains in your chest, abdomen, or back, talk with a doctor.

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Because the aorta is such a large blood vessel, aneurysms that develop at various locations have different names and unique health risks and treatment challenges.

The types of aortic aneurysms include:

  • Thoracic aortic aneurysm: Forming in the portion of the aorta in the chest, this type of aneurysm has several subtypes, including the aortic root, ascending aortic, aortic arch, and descending thoracic aortic aneurysms.
  • Abdominal aortic aneurysm: Located between the chest and the tops of the legs, this aneurysm is more common than thoracic aortic aneurysms.
  • Thoracoabdominal aortic aneurysm: Spanning portions of the thoracic and abdominal regions of the aorta, this type can be especially challenging to treat because the arteries from these regions feed most internal organs.

When an aortic aneurysm does cause noticeable symptoms, they’re often the same symptoms that can accompany other conditions, including:

A 2017 case study suggests that on an echocardiogram (echo), the bulge of a hiatal hernia pushing out from the stomach into the diaphragm can also be mistaken for a descending thoracic aortic aneurysm.

Most aortic aneurysm symptoms are the same for females and males. But there can be some differences.

For example, a ruptured abdominal aortic aneurysm can cause shooting pain in the middle or side of the abdomen in both males and females. But in males, the pain can extend down to the scrotum.

Diagnosing an aortic aneurysm usually involves a physical examination and imaging.

A doctor will listen to your heart with a stethoscope. Signs of an aortic aneurysm might include a heart murmur, weaker heartbeats, or other changes from your normal heartbeats.

Unusual pulse rates in your arms and legs may also indicate circulation concerns, such as an aortic aneurysm. Your doctor may also gently press areas along your abdomen that might indicate the presence of a bulge in the aorta.

Which imaging tests a doctor orders differ depending on what type of aneurysm they suspect. An ultrasound may reveal an abdominal aortic aneurysm. If it appears there is one, a CT scan or MRI may follow to reveal more about the location and shape of the aneurysm.

Echocardiography can help assess a thoracic aortic aneurysm, especially if it’s near the heart. A CT scan or MRI may be recommended if the echo detects a possible aneurysm.

An abdominal aorta with a diameter greater than 3 centimeters (1.18 inches) represents an aneurysm. The size of a thoracic aortic aneurysm depends on several factors including sex, age, and which part of the thoracic aorta is being measured.

Smoking is the leading cause of aortic aneurysms. According to a 2018 study, the association between smoking and aortic aneurysm formation may be stronger among females than males.

Other causes and risk factors for an aortic aneurysm include:

How an aortic aneurysm develops

Aortic aneurysms can develop slowly from atherosclerosis (the gradual hardening and narrowing of the arteries) or high blood pressure. Aneurysms can sometimes form more quickly. For instance, blunt trauma to the chest may cause a thoracic aortic aneurysm to form.

An infection that involves the bloodstream may also cause problems in the arteries, including the formation of an aortic aneurysm.

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An aortic aneurysm can be a life threatening condition if it ruptures.

Females tend to have smaller aneurysms that rupture and often face worse outcomes than males. For these reasons, it’s important to manage risk factors, such as smoking and high blood pressure, and to work closely with a doctor to monitor your cardiovascular health and respond quickly to symptoms.

Because aortic aneurysm symptoms can mimic those of less-serious conditions, you need to remain vigilant and follow your instinct if it tells you something serious is wrong. Some simple imaging and a physical exam can usually determine whether an aortic aneurysm is present.