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Case Reports
. 2015 Jun 24:9:147.
doi: 10.1186/s13256-015-0629-1.

Ortner's syndrome presenting as thoracic aortic aneurysm mimicking thoracic malignancy: a case report

Upul Pathirana  1 , Saman Kularatne  2 , Sumana Handagala  3 , Gamini Ranasinghe  4 , Ravinda Samarasinghe  5
Affiliations
Case Reports

Ortner's syndrome presenting as thoracic aortic aneurysm mimicking thoracic malignancy: a case report

Upul Pathirana et al. J Med Case Rep. .

Abstract

Introduction: Ortner's syndrome is defined as left recurrent laryngeal nerve palsy caused by a cardiovascular pathology. Here we report the case of a 68-year-old man who presented to our hospital with hoarseness, whose initial chest imaging mimicked a thoracic neoplastic process with left pleural effusion. The final diagnosis was Ortner's syndrome due to the silent rupture of a thoracoabdominal aortic aneurysm. Diagnostic thoracentesis, before computed tomography, in resource-poor settings, may have resulted in an adverse outcome in our case.

Case presentation: A 68-year-old Sri Lankan man was referred to us by an otolaryngologist for further evaluation of a suspected thoracic malignancy. His presenting symptom was hoarseness of three months duration. He had essential hypertension for the last four years and had a history of 25 pack-years of cigarettes smoking. His chest X-ray showed a left-sided mediastinal mass with mild to moderate pleural effusion. An ultrasound appeared to show an encysted pleural fluid collection. However, we proceeded with computed tomography before diagnostic thoracentesis. The diagnosis of Ortner's syndrome was made after the computed tomography due to the silent rupture of his thoracoabdominal aortic aneurysm.

Conclusions: Hoarseness due to left recurrent laryngeal nerve palsy can be the presenting symptom of cardiovascular pathologies, Ortner's syndrome. Silent rupture of thoracic aortic aneurysms can mimic that of thoracic malignancy, which is reported in literature. We illustrate the importance of a high degree of suspicion of cardiovascular pathology in order to avoid an adverse outcome following diagnostic thoracentesis.

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Figures

Fig. 1
Fig. 1
Chest X-ray showing a left side mediastinal mass. A homogeneous, soft tissue, dense, well-defined lesion in the left lung (white arrow) extending from the aortic knuckle to the left hemidiaphragm. Its medial margin merges with the mediastinum and there is a left-sided mild to moderate pleural effusion (black arrow)
Fig. 2
Fig. 2
Computed tomography aortography showing ascending (black arrow) and descending (large white arrow) aortic aneurysm with left-sided pleural effusion (small white arrow)
Fig. 3
Fig. 3
Volume-rendered image showing fusiform dilatation of the aorta (white arrow) from the aortic root to the bifurcation
See this image and copyright information in PMC

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