Thoracic aortic aneurysm (TAA) is a common, clinically silent, and potentially fatal condition that is often not identified until catastrophic complications such as dissection or rupture occur. Although the increasing use of advanced imaging modalities has improved detection, early diagnosis remains challenging. TAA development reflects a complex interplay of genetic predisposition, extracellular matrix remodeling, and hemodynamic stress that progressively weakens the aortic wall. Heritable connective tissue disorders and bicuspid aortic valve disease are key contributors to ascending aortic pathology, whereas chronic hypertension and atherosclerotic degeneration are more commonly associated with descending aneurysms. Most patients remain asymptomatic, with symptoms typically arising only in advanced stages or when complications develop; when present, they are often nonspecific and may relate to aneurysm size, rate of expansion, or compression of adjacent mediastinal structures. Diagnosis is primarily imaging-based, with computed tomography angiography serving as the standard for comprehensive evaluation, while echocardiography and magnetic resonance imaging play complementary roles in screening and surveillance. Overall, TAA represents a progressive disease process, and early identification through appropriate imaging and risk-based surveillance is essential to prevent life-threatening complications and guide timely clinical intervention.

Received: 04 February 2026

Accepted after revision: 31 March 2026

Article published online:
28 April 2026

© 2026. International College of Angiology. This article is published by Thieme.

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