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Recurrent choking as a presenting feature of aortic arch aneurysm
Ken-Hing Tan1, Sun-Li Chou, Shih-Yu Ko
1Department of Emergency Medicine, Taipei Medical University - Shuang Ho Hospital, Zhong He City, Taipei County 235, Taiwan ROC.
The American Journal of Emergency Medicine
|April 1, 2011
Summary
An aortic arch aneurysm can cause choking in elderly patients by affecting the vagus nerve. Prompt surgical resection is recommended for symptomatic or rapidly expanding aneurysms.
Area of Science:
- Cardiology
- Neurology
- Gastroenterology
Background:
- Aortic arch aneurysms are more prevalent in older adults.
- Symptomatic or rapidly expanding aneurysms warrant surgical intervention.
- Swallowing is a complex neuromuscular process involving oral, pharyngeal, and esophageal phases.
Observation:
- An 87-year-old male presented with choking during a meal.
- Neurological symptoms such as hoarseness or dysphagia were absent.
- The patient was diagnosed with an aortic arch aneurysm.
Findings:
- The pharyngeal phase of swallowing is regulated by the glossopharyngeal and vagus nerves.
- Enlargement of an aortic arch aneurysm can stretch the left vagus nerve or its plexus.
- This nerve compression may lead to uncoordinated pharyngeal muscle activity, causing choking.
Implications:
- Aortic arch aneurysms can present with atypical symptoms like choking.
- Vagus nerve involvement is a potential mechanism for dysphagia in aortic arch aneurysm patients.
- Early diagnosis and surgical management of aortic arch aneurysms are crucial to prevent complications.
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