title: 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.
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Tri-Service General Hospital of the National Defense Medical Center, No. 325 Cheng-Kung Road Section 2, 114 Taipei, Taiwan, ROC.
authors.forename: Hsin-Chien
authors.initials: HC
authors.lastname: Chen
authors.forename: Chao-Jung
authors.initials: CJ
authors.lastname: Lin
authors.forename: Yuan-Sheng
authors.initials: YS
authors.lastname: Tzeng
authors.forename: Chien-Sung
authors.initials: CS
authors.lastname: Tsai
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Wang
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D004562:Electrocardiography; D006261:Headache / Q000209:etiology; D006685:Hoarseness / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D014057:Tomography, X-Ray Computed