Hoarseness as an unusual initial presentation of aortic dissection

Abstract

Aortic dissection is a life-threatening medical emergency. While an abrupt, tearing pain in the chest or back is present in more than 90% of the patients, diagnosis of aortic dissection has been shown to be particularly difficult when such symptoms are not present. In this report we describe a 36-year-old man presenting with a 10-day history of new onset of hoarseness associated with several transient headache episodes. The possibility of aortic dissection was overlooked at the initial presentation, and unilateral vocal cord palsy due to a cerebrovascular accident was the initial diagnosis. The patient's abnormal chest radiograph led to a re-diagnosis, and a Standford type-B aortic dissection was confirmed using thoracic computed tomography. The unusual presentation of aortic dissection is emphasized, and its management is discussed.

Cardiovocal syndrome secondary to a giant aortic arch aneurysm

“…In patients with left vocal fold palsy, lesions originating from the aortic arch level are highly likely to have an anatomic course to the left recurrent laryngeal nerve. Cardiovascular problem, such as life-threatening aortic dissecting or impending aneurysm rupture, can lead to hoarseness in patients because location and size of the dilated aortic arch may contribute to recurrent nerve paralysis [1].…”

“…Cardiovascular, inflammatory and neurological disorders can also result in vocal cord paralysis. The term, cardiovocal syndrome, also called Ortner's syndrome, has come to encompass any cardiovascular process that results in recurrent laryngeal nerve damage and vocal cord paralysis [1].…”

“…These cardiovascular disorders, including mitral stenosis, cor pulmonale, pulmonary hypertension, aortopulmonary window, Ebstein's anomaly, aortic dissecting and aortic aneurysms, may cause vocal fold paralysis [1].…”

Ortner’s syndrome: A rare case of hoarseness secondary to chronic aortic dissection

“…These include stroke, paraplegia, syncope, transverse myelopathy, hoarseness, dysphagia, and lower extremity numbness. 6 , 12 – 16 …”

Ortner Syndrome: A Rare Presentation of Aortic Dissection Causing Compression of the Laryngeal Nerve

“…Computed tomography (CT) is the diagnostic procedure of choice in diagnosis of aortic dissection and should be performed from the skull base to mid-thorax when unspecified cause of newly diagnosed vocal cord palsy is noted (6). After appropriate management of aortic dissection, the prognosis of Ortner syndrome improves with early diagnosis and treatment before fibrosis and perineural scarring of the recurrent laryngeal nerve occur (7).…”