Chronic cough: a herald symptom of thoracic aortic aneurysm in a patient with a bicuspid aortic valve

Abstract

Chronic cough has a wide differential, of which thoracic aortic aneurysm is a rare but potentially devastating cause. We present a patient with previous aortic valve replacement for a bicuspid valve who had been suffering from a chronic cough for 8 months and who developed subsequent voice hoarseness. This had been initially managed in the community with trials of steroid inhalers, steroid nasal sprays and proton pump inhibitors to no avail. He was referred to cardiology and chest clinics. An urgent CT aortogram was requested given his widened mediastinum on chest radiograph, cardiac history of bicuspid valve and symptoms. This revealed a large aneurysm of the thoracic aorta with chronic dissection that required urgent operative intervention. His cough resolved 6 weeks postoperatively. The purpose of this report is to highlight thoracic aortic aneurysms as a potential rare differential for chronic cough and as a complication of patients with bicuspid aortic valves.

Hoarseness Due to Aortic Arch Aneurysms

“…Hoarseness was a sole symptom in 32 (36.8%) patients [ 1 , 9 , 11 , 12 , 18 , 21 , 22 , 31 - 34 , 36 , 41 , 43 , 45 , 47 , 50 , 54 - 56 , 58 , 59 , 62 , 63 , 65 - 68 , 74 , 75 ] , a major symptom in 34 (39.1%) patients [ 2 , 5 , 6 , 8 , 10 , 13 - 16 , 19 , 24 , 28 , 31 , 32 , 38 , 39 , 44 , 46 , 49 , 51 - 53 , 57 , 61 , 64 , 70 ] , and an accompanying symptom in 21 (24.1%) patients [ 3 , 4 , 7 , 17 , 20 , 23 , 25 - 27 , 29 , 30 , 32 , 35 , 37 , 40 , 42 , 48 , 60 , 69 , 72 , 73 ] (χ [ 2 ] =5.1, P =0.079).…”

Analysis of patients with thoracic aortic aneurysm taking into account risk factors, procedure and prognosis in 5-year clinical observation

“…We wczesnych etapach rozwoju TAA są zwykle bezobjawowe. W bardziej zaawansowanych przypadkach objawami mogącymi sugerować obecność tętniaka są: ból w klatce piersiowej, ból pleców, dysfagia, chrypka, kaszel, duszność, krwotok, nawracające zapalenie płuc oraz zespół Hornera [6,12]. W diagnostyce tętniaków używa się badań obrazowych, takich jak: zdjęcie rentgenowskie klatki piersiowej (RTG), echokardiografia (UKG), ultrasonografia (USG), angiografia tomografii komputerowej (Angio-TK), angiografia rezonansu magnetycznego (Angio-MR) oraz aortografia [13].…”

Extrinsic tricuspid valve compression due to an aortic aneurysm causing significant right to left shunt via a patent foramen ovale: a case report

“… 1 Although most patients with thoracic aneurysms are asymptomatic, some become symptomatic due to aortic regurgitation and associated heart failure. 2 Large thoracic aneurysms may produce symptoms due to local compression effects such as cough, 3 breathlessness, 4 dysphagia, 5 hoarseness, 6 and back pain. 7 There is a rare but recognized complication of platypnoea–orthodeoxia syndrome (POS) secondary to distortion of the atrial septal anatomy and episodic right to left shunting via a patent foramen ovale (PFO) by the aortic aneurysm.…”