PT  - JOURNAL ARTICLE
AU  - Bhupinder Singh
AU  - Abhishek Goyal
AU  - Shibba T Chhabra
AU  - Naved Aslam
AU  - Bishav Mohan
AU  - Gurpreet S Wander
TI  - Image of the month: An unusual cause of cough, stridor and dyspnoea: A giant aortic arch aneurysm
AID  - 10.7861/clinmed.2021-0095
DP  - 2021 May 01
TA  - Clinical Medicine
PG  - e313--e314
VI  - 21
IP  - 3
4099  - http://www.rcpjournals.org/content/21/3/e313.short
4100  - http://www.rcpjournals.org/content/21/3/e313.full
SO  - Clin Med2021 May 01; 21
AB  - A 78-year-old man with hypertension presented with dry cough and gradually progressive dyspnoea for 3 months. The patient had an audible stridor. Cardiovascular examination was unremarkable. Respiratory system examination revealed both inspiratory and expiratory grunting sound. Laboratory investigations were normal. Electrocardiography showed sinus rhythm with left ventricular hypertrophy (LVH). Chest X-ray showed superior mediastinal widening. Transthoracic echocardiography showed preserved LV functions and dilated aortic arch. Contrast-enhanced computed tomography of the thorax showed a huge aortic arch aneurysm compressing the adjacent trachea. The patient was planned for hybrid aortic arch repair but the patient refused and was discharged on antihypertensive, antiplatelet and statin therapy. The patient continued to have limiting cough, dyspnoea and stridor for 4 months of follow-up until he suddenly died while at home. This case highlights an unusual presentation of a potentially lethal disease. Evaluation of patients presenting with cough and dyspnoea should not be restricted to respiratory diseases. The critical observations made from history