A 56-year-old woman with stress-induced hoarseness
- 1Department of Internal Medicine, Division of Nephrology, Robert-Bosch Hospital, Stuttgart, Germany
- 2Department of Thoracic, Cardiac and Vascular Surgery, Robert-Bosch Hospital, Stuttgart, Germany
- Correspondence to Dr Joerg Latus,
A 56-year-old woman was admitted to hospital due to stress-dependent hoarseness and hypertensive urgency. The patient reported peaks of blood pressure of 210/160 mm Hg in combination with hoarseness. With indirect mirror examination, the ear-nose-and throat doctor diagnosed a paralysis of the vocal cord on the left side. The authors suspected a mass affecting the vagus nerve and performed a CT-scan with iodinated contrast material of the neck and thorax. Surprisingly the CT-scan showed an aneurysm of the aortic arch with a dilatation up to 4.8 cm, a kinking of 120° and a chronic dissection in the aneurysm. During exercise or elevated blood pressure this aneurysm expanded and made a compression of the nervus laryngeus recurrens on the left side. Thus, there is an explanation for the patient’s hoarseness on exertion and during hypertensive urgency.
Competing interests None.
Patient consent Obtained.