SILENT KILLER AORTIC SYNDROME: A Case Series

Objective: We report a case series of Silent Killer Aortic Syndrome, characterized by various pathologies detected via computed tomography (CT) in the infrarenal aortic segment, where the aortic diameters measured below the gender-specific normal range. Background: Small Aortic Syndrome (SAS) is believed to result from intrauterine hypoplasia affecting the development of the abdominal aorta and iliac arteries. A related but distinct entity is abdominal aortic coarctation, a condition far less common than coarctation of the aortic isthmus. This case series aims to highlight the diagnostic challenges posed by these overlapping pathologies and to emphasize the clinical implications of SAS in affected individuals. Methods: This retrospective, single-center study evaluated anterior-posterior diameter measurements of the infrarenal abdominal aorta using CT. Infrarenal aortic diameters were considered pathologic when measuring less than 16 mm in men and less than 15 mm in women, based on sex-specific reference values. CT images were also assessed for the presence of additional concurrent aortic and extra-aortic pathologies, which were included in the analysis. Results: A total of 12 patients were included in the study, comprising 4 females and 8 males. All patients had a history of hypertension. Ascending aortic aneurysms were observed in 7 patients. Bicuspid aortic valve was identified exclusively in male patients. Interestingly, dissection and thrombus formation were more frequently observed in female patients compared to males. Conclusions: Silent Killer Aortic Syndrome represents a newly proposed clinical entity. Given its association with potentially fatal surgical emergencies, long-term surveillance of patients with this pathology is essential. Increased awareness and early identification may improve outcomes and reduce mortality.