Thoracic aortic aneurysm (TAA) presents with which of the following?

• A. Chest pain only
• B. Abdominal pain and leg swelling
• C. Pain in neck and back with airway compression signs and edema in neck/arm; stridor
• D. Numbness of extremities

Answer: (C)

Expansion of a thoracic aortic aneurysm can press on nearby mediastinal structures, so its presentation often includes both pain and signs of compression. The aneurysm itself can cause neck and back pain from the expanding mass. If it grows enough to press on the trachea or other airway structures, you can see airway compression signs such as stridor. Venous compression by the enlarging aorta can impede drainage from the head and upper extremities, leading to edema in the neck and arms. Taken together, the combination of neck and back pain with airway compression signs and neck/arm edema, plus stridor, fits the pattern of a thoracic aortic aneurysm compressing adjacent structures.

The other descriptions don’t align as well with TAA. Abdominal pain with leg swelling points toward an abdominal aneurysm or peripheral venous issues rather than a thoracic process. Numbness of the extremities suggests nerve or spinal involvement rather than mediastinal compression from the thoracic aorta. Chest pain alone could be from many conditions and doesn’t emphasize the compressive symptoms seen with a mediastinal aneurysm.