Objective: The purpose of this case report was to describe chiropractic management of thoracic pain in a patient with a stable thoracic aortic aneurysm. Clinical features: An 89-year-old man presented with axial mid- and upper back pain localized predominantly at the T8 and T1 spinal segmental levels. A review of available imaging revealed a stable aneurysmal dilatation of the ascending aorta, which measured 4.3 cm. Intervention and outcome: Because the thoracic pain was musculoskeletal in nature and the thoracic aortic aneurysm was stable, mechanical manipulation was provided using the Impulse adjusting instrument. The patient's pain was measured utilizing a numeric rating scale. The patient's thoracic pain improved over the course of treatment. Conclusion: This patient was successfully treated for thoracic spine pain with a course of chiropractic care using a mechanical adjusting instrument.