Delayed Resolution of Hoarseness following Bronchial Artery Embolization for a Bronchial Artery Aneurysm: A Case...

Bronchial artery aneurysms (BAAs) are rare vascular lesions that require prompt treatment because of the risk of rupture, which can be life-threatening regardless of their size. Hoarseness caused by recurrent laryngeal nerve (RLN) palsy secondary to BAA is extremely uncommon, and delayed clinical improvement after treatment has rarely been reported. Herein, we report a case of a mediastinal BAA presenting with hoarseness that gradually resolved following bronchial artery embolization (BAE).

A 73-year-old woman presented with hoarseness persisting for 8 months. Laryngoscopic examination revealed left vocal cord paralysis, and contrast-enhanced CT demonstrated a 36-mm mediastinal BAA associated with markedly dilated and tortuous bronchial arteries and bronchiectatic changes in the left lower lobe. The aneurysm was deemed to be responsible for compression of the left RLN. BAE was subsequently conducted using coil embolization of both the aneurysm sac and the feeding artery. The postoperative course was uneventful, and the patient was discharged on POD 3. Follow-up CT at 7 months revealed a reduction in aneurysm diameter from 36 to 25 mm, with near-complete disappearance of intra-aneurysmal blood flow. Hoarseness gradually improved during follow-up and completely resolved 17 months following embolization.

RLN palsy caused by BAA is rare. Postoperative laryngoscopic confirmation of vocal cord motion was unavailable. However, this case demonstrates that hoarseness may gradually resolve long after endovascular treatment. Progressive aneurysm shrinkage following embolization may have gradually relieved compression of the RLN, thereby contributing to the delayed improvement in hoarseness. Therefore, long-term follow-up should be considered in patients with BAA presenting with hoarseness.