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

Abstract

We 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.

Figure 1

(A–D) Dissection in the descending thoracic aortic arch, 1 cm distal to the left subclavian artery, with an important evidence of a transmural ulcer of about 3×4 cm in diameter, in contact with the left pulmonary artery.

Figure 2

(A) Abdominal aortic dissection that extends to the left common iliac artery with an aneurysm dilation and mural thrombosis. A permeable stent is seen in the right common iliac artery. (B) The arrow demonstrates the intimal flap in relation with the abdominal aortic dissection.