Thoracic Aortic Aneurysms in Children

Abstract

Aneurysms of the thoracic aorta in children, though rare, occur frequently enough to warrant attention, because a group of them are a part of the much more common rheumatic fever syndrome. A great diversity of opinion has existed regarding the etiology of the thoracic aneurysm in the young. Some authors have believed that syphilis is practically always the prime factor in children as in adults, but a careful study of the available cases does not confirm this view.The etiologic factors in the production of aortic aneurysms in childhood have been classified by Bronson and Sutherland 1 in the following manner: (1) atheromatous degeneration; (2) trauma (rare); (3) erosion of the aorta from without; (4) congenital malformation (in a few cases), and (5), probably the most important, acute infectious diseases.Up to the present forty-four cases of aneurysm of the thoracic aorta in persons under 18 have been reported. In twenty-one of the cases there was an association with endocarditis (ten instances) or clinical rheumatic fever (eleven). In all of the cases of the former group autopsies confirmed the presence of lesions in the endocardium as well as in the aorta. In the latter group autopsy was performed in only one case, in which in addition to a dissecting aneurysm of the aorta there were mild coarctation and acute pericarditis with hemopericardium ; a year before death the patient had pains and swelling of the joints.-Two cases of this group were seen and reported by one of us (J. K. C.s) ; the patients gave a definite history of rheumatic fever and there were physical findings of rheumatic heart disease. Evidence

Thoracic Aortic Dissection in an 18-Year-Old Woman with no Risk Factors

“…Other congenital cardiovascular malformations, including bicuspid aortic valves and coarctation of the aorta, increase the risk for dissection in the young (1,4). The role of childhood infections such as rheumatic fever has been explored by investigators as well (7). The presence of proximal aortic dilatation in many of the younger patients apparently points to an increased frequency of abnormalities in the aortic media (1).…”