Chronic voice hoarseness: when is it an emergency?

We report a 68-year-old man with chronic voice hoarseness, who presented to the emergency room with left-sided chest and hypochondrial pain. Chest radiograph showed a large mediastinal mass confirmed to be a thoracic aortic aneurysm by an emergent computed tomography scan. Examination and investigations of a patient with voice hoarseness and chest pain should focus on looking out for dissecting or leaking aneurysms, which may be catastrophic if missed.