A delayed diagnosis of Stanford non-A non-B aortic dissection presenting as Ortner syndrome: A case report

The clinical presentation of aortic dissection is diverse and requires a high degree of suspicion to make a clinical diagnosis. Typical chest pain is present in about 80 to 90% of patients. Sometimes, acute aortic dissection may present with only a subtle intimal flap, potentially leading the lesion being overlooked on initial imaging studies. The lesion may evolve over time and later present as chronic aortic dissection with complications, mainly due to compression of adjacent structures. We describe a patient who initially presented with acute chest pain and hypertensive emergency later developing vocal cord palsy secondary to compression of the recurrent laryngeal nerve by an aortic dissection, consistent with Ortner syndrome. The dissection was classified as Stanford type non-A non-B. This subtype of aortic dissection is rarely reported in the literature, and its associated complications have only infrequently been described. Medical management is appropriate for stable chronic aortic dissections due to the high morbidity and mortality risk of surgery.  This case also highlights the importance of careful evaluation of patients presenting with high blood pressure and acute chest pain.