The Teaching Point

Potentially life-threatening cardiac and vascular pathologies such as aortic aneurysms warrant early imaging and detection and may occasionally present with seemingly unrelated and benign symptoms and signs such as hoarseness. In the approach of an uncommon presentation, it is prudent to revisit fundamental principles of anatomy and physiology such as the course of the recurrent laryngeal nerve in order to recommend appropriate investigations.






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From the manuscript

A Case of Hoarseness with Acute Back Pain - Cardiovocal Syndrome Revisited

Free full text article: A Case of Hoarseness with Acute Back Pain - Cardiovocal Syndrome Revisited

Abstract
A previously well 81-year-old Chinese male presented with hoarseness and low back pain for one month. Chest radiography at presentation revealed widening of the mediastinal silhouette. Nasopharyngoscopy detected left vocal cord paralysis. CT aortogram revealed a large saccular aortic arch aneurysm with a dissection flap extending distally down to the aortic bifurcation. The combination of clinical and imaging findings was consistent with cardiovocal syndrome. In view of good premorbid function, surgical repair was offered, and the patient underwent surgical repair and recovered well with no further back pain. A review of cases of cardiovocal syndrome suggest that prognosis of recurrent laryngeal nerve paralysis is dependent on the degree and duration of compression, and usually persists despite treatment of the underlying aneurysm.






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