Stridor, dysphagia and dysphonia…unusual triad in aortic arch aneurism

Introduction: Thoracic aortic aneurisms can present with a variety of symptoms, some of them due to compressions on the surrounding structures. Stridor is an abnormal, high-pitched sound produced by turbulent airflow through a partially obstructed upper respiratory airway and is a rare manifestation of a thoracic aortic aneurism. Moreover, cardiovocal (or Ortener’s) syndrome consisting in disphonia due to a cardiovascular cause can be a rare sign of aortic pathology, secondary to recurrent laryngeal nerve. Methods: We report a case from a Tertiary University Hospital, the case of a man with thoracic aortic aneurism presenting with an unusual triad, dysphonia, dysphagia and stridor. Results: A 57 year old hypertensive man was admitted as an emergency with acute dypnea along with a 3 day history of dysphagia and dysphonia. He was distressed, tachypnoeic, tachycardic and hypertensive (blood pressure 170/90 mm Hg). Stridor could be heard without a stethoscope. Chest X-ray showed a mass over the right upper chest suggesting an aortic aneurysm with compression and displacement of the trachea. Therefore it appeared the symptoms were caused by a huge thoracic aortic aneurysm with tracheal compression. Chest CT confirmed the diagnosis of a saccular aneurism located on the inferior wall of the aortic arch with a parietal thrombosis compressing the trachea and the medium segment of the oesophagus. The patient underwent emergency surgery and he was discharged home a few days later. Conclusions: This case highlights a recognised, but un common cause of stridor. Moreover, the association of the cardio-vocal syndrome and disphagia completed a diagnostic triad for aortic arch aneurism.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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