Hoarseness for 1Week.

Abstract

A 73-year-old woman presented to the emergency department with a 1-week history of hoarseness, dysphagia, and dyspnea. On physical examination, she had jugular vein distension, a harsh systolic murmur at the left upper sternal border, and a significant splitting of S2. Flexible laryngoscopy revealed left vocal cord paralysis (Figure 1A). Chest x-ray study revealed cardiomegaly and dilatation of the main pulmonary artery (Figure 1B). Chest computed tomography showed aneurysmal dilatation of the main pulmonary artery up to 50.8 mm (normative pulmonary artery diameter of 29 mm in men and 27 mm in women) (Figures 1C and 1D).