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June 1, 2006
Aortic aneurysms
Q: I am a 75-year-old male. My doctor discovered that I have an enlarged aorta. He arranged for me to have an ultrasound examination of it. The result is that the enlargement is an aneurysm with a 4.2 centimetre diametre. He said he would have it checked again in six months. Please tell me your thoughts on this.
A: The aorta, the body’s largest artery, arises directly from the heart and travels downward through the chest to the bottom of the abdomen. There it divides into two arteries that supply the legs with blood. All through its course it gives off smaller arteries that provide blood to all parts of the body.
An aortic aneurysm is a weak spot in the wall of that artery. The weak spot permits the wall to balloon outward. The danger from an aneurysm is the possibility of its bursting and causing massive internal bleeding. Most aortic aneurysms form in the abdominal section of the aorta, and most, especially early on, produce no symptoms.
The aorta’s normal diametre is 2.54 cm (one inch). When the diametre reaches 5.5 cm (2.2 inches), the risk of rupture is great enough to warrant surgical correction. Surgery entails shoring the wall of the aorta with a synthetic graft.
Smaller aneurysms can be safely watched by scheduling periodic ultrasound measurements. Should the aneurysm reach the critical width or should it expand more than one centimetre (0.4 inches) in one year, then it is time for surgery. Some never enlarge.
Doctors are gaining experience with a new technique for aneurysm repair. A stentlike graft is snaked to the site of the aneurysm through an artery in the upper leg. This procedure is less demanding for the patient than is surgery. If it proves to be as effective and long-lasting as surgical correction, it could become the procedure of choice.
Q: I have quite a few brown spots on my chest and back. They are rough to the touch and vary in size, with some being as large as a dime. I was told they could be keratoses. Would you explain what that is and if they are malignant? I am 84. I have had them for 10 years.
A: Almost every adult has one or more seborrheic keratoses, and some have hundreds. Their surface can be smooth, or it can be rough with cracks or crisscrossing fissures. The colour varies from tan to brown to black, and the size varies from not much bigger than a large freckle to as large as 1.2 inches (three cm) in diametre. Keratoses have very well-defined borders; they don’t blend into adjacent skin. They look like they’ve been glued on the skin. They might itch.
Seborrheic keratoses are not cancer and do not become cancer. They are a nuisance more than anything. If a person wants, they can be frozen off with liquid nitrogen or scraped off with an instrument called a curette, or they can be left alone.
Your description fits that of seborrheic keratoses. However, brown spots that have not been diagnosed by a doctor’s experienced eye are always a source of concern. You should ask your doctor to take a look at them. Some pigmented skin lesions, as you know, are melanomas. Having had yours for 10 years makes melanoma an unlikely diagnosis, but erring on the side of safety is a sensible policy.
Dr Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write to him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.
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