Giant aortic arch aneurysm presenting with hoarseness of voice.

A middle-aged male with hypertension and dyslipidaemia presented with hoarseness of voice due to a left vocal palsy. The chest radiograph revealed a saccular opacity silhouetting the left border of the aortic knuckle, suggestive of a large aortic arch aneurysm. Routine investigations, such as a chest radiograph do occasionally identify potentially fatal pathology, even when perhaps not strictly indicated; uncommon presentations do occur!