Aortic dissection is caused by a circumferential or transverse tear of the intima by a discrepancy between the strength of the aortic wall and the intraluminal pressure.

Arterial hypertension seems clearly to be a factor in the genesis of aortic dissection.

An elevated blood pressure or evidence of its existence can be found in 70-80 percent of patients. Other factors predisposing to aortic dissection are congenital disorder of connective tissue, vasculitis, etc. But trauma or physical strain is unusual cause of classic dissection.

Diagnosis is confirmed by computed tomography, aortography or echocardiography.

A 62-year-old man without a history of hypertension, emphysema or congestive heart failure visited our hospital because of hoarseness which developed suddenly during the physical strain. A contrast material-enhanced computed tomographic (CT) scan was performed at an other hospital due to hoarseness, mild fever and general weakness. Then he visited to our ENT department and performed laryngeal CT due to hoarseness. The CT shows somewhat mass-like soft tissue, so he was transferred to our internal medical department.

The chest CT scan and simple chest PA was done and we found a dissecting aneurysm.

This case developed by Physical strain and diagnosed by hoarseness is unusual and rare.

During the period from Sep.,1993 to Dec.,1997, in a series of 148 patients with anterior cervical fusions on using a modified Smith-Robinson technique, long-term follow-up results complete with historical evaluation or laryngeal examination were obtained in all patients. The visualization of the underlying pathology was adequate through magnification of the operating microscope in the anterior approach.

The complications were analyzed on the basis of 157 operative cases in 148 patients treated surgically right sided approach with variable underlying pathologies. The most common complication was a postoperative hoarseness in 8(5%), but risks and complications of the procedure were few in spite of right sided approach.

Measures to minimize the incidence of vocal cord paralysis include careful surgical techique and knowledge of the surgical anatomy of the laryngeal nerves. Suggestions are given for the assessment of postoperative hoarseness, and for the management of vocal cord paralysis.