General responses to selected questions from Joel Braunstein, MD, of Johns Hopkins University and Joseph Toscano, MD.
Question:
Five years ago when I had throat surgery, a chest X-ray was required. I just recently noticed a statement indicating the X-ray showed a calcified aortic knob. At the time of the surgery, no mention was made of this by any doctor. Since I am elderly, should I be concerned that this might be life-threatening?
Answer:
While aortic calcification likely signifies that you have some atherosclerosis in your aorta, you should feel reassured to know that aortic calcification is almost uniformly present in all individuals aged beyond their middle years. Atherosclerosis is an inevitable process of aging, and aortic calcification merely reflects this process. While calcification is associated with a slightly higher risk of stroke and heart attack (particularly during surgeries that involve manipulation of the aorta, like coronary artery bypass grafting), most calcification occurs without incident.
Occasionally, however, aortic calcification can be associated with more serious conditions, such as aortic dissection or aneurysm, Takayasu's arteritis (a rare inflammatory disorder of large blood vessels), and syphilis arteritis (inflammation of the aorta due to a chronic, untreated syphilis condition). For an elderly person like you, aortic dissection and/or aneurysm are likely to be the only real considerations beyond some degree of atherosclerosis.
Managing cardiovascular risk factors is the most effective way to reduce the severity or worsening of aortic atherosclerosis. Like coronary artery disease, atherosclerosis in the aorta responds favorably to cholesterol reduction, blood pressure and diabetes control, elimination of smoking, exercise and a healthy diet. You should discuss the calcification with your doctor to determine whether there are some additional strategies you can pursue to fully protect yourself from future cardiovascular disease. In that case, and if it is a real concern, your doctor may also consider obtaining an echocardiogram to better quantify the extent of calcification of your ascending aorta and aortic valve. In the meantime, enjoy life and try not to let this incidental finding on a chest X-ray generate too much anxiety for you.
