Hoarseness may rarely indicate cardiovascular pathology and have important anesthetic implications. We report a 67-year-old man with preoperative hoarseness, a saccular aortic arch aneurysm, and radiological tracheal deviation. Although conventional airway assessment was unremarkable, a potentially difficult airway was anticipated. Videolaryngoscopy revealed reduced left vocal cord mobility in a paramedian position, and tracheal intubation was achieved without technical difficulty. This case emphasizes preoperative hoarseness as a warning sign of altered airway anatomy in cardiovocal syndrome and highlights the importance of careful airway assessment, preparation, and anesthetic planning.
Keywords: Anesthesia management, aortic arch aneurysm, cardiovocal syndrome, difficult airway, Ortner syndrome