title: A 56-year-old woman with stress-induced hoarseness.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Robert-Bosch Hospital, Stuttgart, Germany. Joerg.latus@rbk.de
authors.forename: Joerg
authors.initials: J
authors.lastname: Latus
authors.forename: Ulrich
authors.initials: U
authors.lastname: Franke
authors.forename: M Dominik
authors.initials: MD
authors.lastname: Alscher
authors.forename: Niko
authors.initials: N
authors.lastname: Braun
mesh_terms: D000784:Aortic Dissection / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001013:Aorta, Thoracic; D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006685:Hoarseness / Q000209:etiology*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D008875:Middle Aged; D005082:Physical Exertion; D014057:Tomography, X-Ray Computed; D014826:Vocal Cord Paralysis / Q000175:diagnosis
chemical_list: D000959:Antihypertensive Agents; D003287:Contrast Media