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Stridor From a Concealed Perforated Aortic Aneurysm.

A 79-year-old man presented to our emergency room with acute dyspnea and new inspiratory and expiratory stridor. Thoracic computed tomography (CT) in an out-ofhospital setting 6 months previously had shown aneurysmatic bulging of the aortic arch with incipient tracheal displacement. According to the patient, no treatment ensued. Suspecting progression of the aortic aneurysm with constriction of the lower (intrathoracic) airways, we immediately repeated thoracic CT. This revealed a concealed perforated aneurysm of the aortic arch with a maximum diameter of 9 cm. The trachea was markedly displaced and its lumen compressed to as little as 3 mm. The patient was transferred for cardiothoracic surgery and underwent combined replacement of the ascending aorta, aortic arch, and descending thoracic aorta by means of the frozen elephant trunk technique. His postoperative recovery was free of complications, and he went on to complete a course of medical rehabilitation. This case illustrates the importance of thorough history taking and precise diagnostic differentiation between inspiratory stridor and the much more commonly occurring expiratory stridor in patients with acute obstructive ventilation disorders.