BMJ Case Reports 2012; doi:10.1136/bcr.01.2012.5688
  • Unusual presentation of more common disease/injury

A 56-year-old woman with stress-induced hoarseness

  1. Niko Braun1
  1. 1Department of Internal Medicine, Division of Nephrology, Robert-Bosch Hospital, Stuttgart, Germany
  2. 2Department of Thoracic, Cardiac and Vascular Surgery, Robert-Bosch Hospital, Stuttgart, Germany
  1. Correspondence to Dr Joerg Latus, Joerg.latus{at}


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.

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