Acute Contained Ruptured Aortic Aneurysm Presenting as Left Vocal Cord Paralysis

Objectives: Recognize intrathoracic abnormalities, including expansion or rupture of aortic aneurysms, as a source of acute onset vocal cord paralysis. Methods: Case report and review of the literature. Results: An 85-year-old female with prior history of an aortic aneurysm status post-endovascular repair presented to a tertiary care laryngology clinic with a history of sudden onset hoarseness that began two months prior with no subsequent improvement. On laryngoscopy, the left vocal cord was seen in the midline position. A computed tomography (CT) scan obtained that day revealed a new, large acute 4.6 cm hematoma surrounding the upper descending aortic stent graft consistent with an acute contained ruptured aortic aneurysm. She was subsequently referred to the Emergency Department for further evaluation and treatment by the vascular surgery team. She was counseled regarding surgical options and ultimately decided not to pursue further treatment. Her vocal cord paralysis was subsequently treated via office-based injection medialization two weeks after presentation and again 5 months after the initial injection which dramatically improved her voice. Follow-up CT scan at 8 months after diagnosis demonstrated a slight decrease in the size of the hematoma and the development of a pseudoaneurysm within it. The left vocal cord remains immobile to date. Conclusions: Ortner’s syndrome, or cardiovocal syndrome, is hoarseness secondary to left recurrent laryngeal nerve palsy caused by cardiovascular pathology. It is a rare condition, and while typically presenting gradually, may also present with acute symptomatology.