Left recurrent laryngeal nerve palsy associated with primary pulmonary hypertension and patent ductus arteriosus

Abstract

Two patients with left recurrent laryngeal nerve paralysis in association with pulmonary artery hypertension are described. One had primary pulmonary hypertension and the other had patent ductus arteriosus. The greatly dilated pulmonary artery in these patients resulted in compression of the left recurrent laryngeal nerve and produced a cardiovocal (Ortner's) syndrome. The pathogenesis of the vocal cord palsy was documented by cross-sectional computed tomography. In conclusion, computed tomography is of great help in differentiating this syndrome from other diseases such as mediastinal mass or lymphadenopathy whenever hoarseness is complicated by pulmonary hypertension.

Compression of adjacent anatomical structures by pulmonary artery dilation

“…Left vocal cord palsy due to LRLN compression was reported in patients with idiopathic PAH [3 26-28], PAH due to CHD [26 29-31] and chronic thromboembolic pulmonary hypertension [24 32]. Interestingly, in several cases, the hoarseness improved upon reducing the pulmonary artery pressure with PAH-specific therapies [3 25 33] (Table 2).…”

Hollow in the Lung with Hoarseness: An Uncommon Association with Pulmonary Thromboembolism

“…Ortner's Syndrome (described 118 years ago in 1897) is a clinical entity with hoarseness due to a left recurrent laryngeal nerve (LRLN) palsy caused by cardiac disease [9]. Left recurrent laryngeal nerve palsy has been reported with extreme rarity in association with moderate to severe pulmonary hypertension [10]. The mechanical cause has been advocated due to compression of RLN between enlarged pulmonary artery and aorta at ligamentum arteriosum [11].…”

Ortners Syndrome: A Rare Cause of Hoarseness of Voice

“…Later it was described with other identifiable cardiovascular diseases associated either with left atrial enlargement including mitral regurgitation and atrial myxoma or severe pulmonary hypertension including congenital heart diseases. For this reason it is also known as cardiovocal syndrome [7][8][9][10][11] . The various underlying conditions associated with cardio vocal syndrome include iatrogenic congenital, mitral valve disorders, and aortic aneurysms (Table 1).…”