Ortner’s syndrome: a case report and review of the literature

Abstract

SUMMARYWe present a case of a 67-year-old man who was an active smoker, with a clinical history of ischaemic cardiopathy, hypertension, who presented to the emergency room with hoarseness of voice of 2 weeks duration. No other neurological or cardiorespiratory symptoms were found. Physical examination revealed an aortic regurgitation murmur with radial pulse difference between the upper limbs and femoral pulse difference on lower limbs. Laryngoscopy examination revealed a left vocal cord paralysis in the paramedian position, without signs of malignancy. Thoracoabdominal CT angiography was performed to rule out an aortic dissection. CT revealed a dissection in the descending thoracic aortic arch and abdominal aorta. Cardiovascular surgery was consulted and decided to place endoprosthesis at the thoracic and abdominal aortic area. Hoarseness eventually resolved during the following weeks. Ortner's syndrome is described as hoarseness of voice caused by compression of the left recurrent laryngeal nerve of cardiovascular origin. BACKGROUND

Ortner’s syndrome secondary to thoracic aortic aneurysm: a case series

“…Ortner’s syndrome is a rare cause of left recurrent laryngeal nerve palsy. The enlargement of any intrathoracic structure close to the recurrent laryngeal nerve such as left atrial enlargement, dilatation of the left pulmonary artery, or TAA can result in compressive nerve palsy [ 2 , 3 ]. In the superior mediastinum, the LRLN is a branch of the vagus nerve that descends antero-lateral to the aortic arch, passes deep to the ligamentum arteriosum and then ascends in the tracheo-esophageal groove.…”

“…Most vocal cord paralysis is due to neoplasia, followed by iatrogenic procedures, and intracranial diseases or aortic diseases also need to be considered. In aortic disease, in addition to TAA, mycotic aneurysm and aortic dissection may also cause hoarseness, and the latter two disorders have other symptoms [ 2 , 4 , 6 ]. Most TAAs are asymptomatic, but some TAA patients may have other symptoms including dysphagia due to compression of the esophagus and breathing difficulties due to incomplete opening of the glottis [ 7 ].…”

Ortner’s syndrome secondary to thoracic aortic aneurysm: a case series

“…Ortner's syndrome is a rare cause of left recurrent laryngeal nerve palsy. The enlargement of any intrathoracic structure close to the recurrent laryngeal nerve such as left atrial enlargement, dilatation of the left pulmonary artery, or thoracic aortic aneurysm can result in a compressive nerve palsy 2,3 . In the superior mediastinum, the left recurrent laryngeal nerve is a branch of the vagus nerve that descends down antero-lateral to the arch of aorta, passes deep to the ligamentum arteriosum and then ascends in the tracheo-oesophageal groove.…”

“…Most vocal cord paralysis is due to neoplasia, followed by iatrogenic procedures, and the intracranial diseases or aortic diseases need to be considered too. In aortic disease, in addition to TAA, mycotic aneurysm and aortic dissection may also cause hoarseness, and most of the latter two have other symptoms 2,4,6 . Most TAAs are asymptomatic, but part of TAA patients may have other symptoms include dysphagia due to compression of the oesophagus and breathing di culties due to incomplete opening of the glottis 7 .…”

Disfonía como manifestación de fuga endoprotésica de aneurisma de aorta: Un caso de síndrome de Ortner

“…19 Dentro de la fisiopatología, Ortner creía que la aurícula izquierda crecida comprimía al nervio laríngeo recurrente, ocasionando isquemia y su posterior degeneración, pero estudios realizados por Fetterolf y Norris determinaron que la aurícula izquierda crecida empujaba a la arteria pulmonar izquierda y esta comprimía al nervio contra la aorta a nivel del ligamento arterioso, cuyo espacio es de cuatro milímetros. 20 Este mecanismo también explica la compresión del nervio laríngeo recurrente izquierdo por otras estructuras cercanas a la ventana aortopulmonar que ocasionan síndrome de Ortner. 21,22 El aneurisma es definido como la dilatación de una arteria por lo menos 1,5 veces su tamaño normal.…”