A case of aortic arch aneurysm with ascending aortic ulcer detected by hoarseness

A 65-year-old male was admitted to our department with chief complaint of ‘hoarseness and choking cough for more than 2 months’, with laryngoscopy showed that the left vocal cord was paralyzed. Further aortic computed tomography angiography (CTA) revealed left lateral aortic arch aneurysms accompanied with a rough ascending aortic wall (Panels A and B). So the primary diagnosis was atherosclerosis with aortic aneurysm. We suspected that aortic arch aneurysms compressed the recurrent laryngeal nerve, resulting in hoarseness. However, in the later three-dimensional reconstruction of aortic CTA, it was suspected that the ascending aorta is ulcerated (Panel C). Multiple ulcers of the ascending aorta and aneurysms on the small curved side of the descending aortic arch were found during the operation (Panel D). The ascending aorta replacement + total aortic arch artificial vascular replacement and stent elephant trunk operation were performed (Panel E)....