Ortner syndrome secondary to saccular thoracic aneurysm

Abstract

Mechanical stretching of the left laryngeal nerve secondary to an enlarged left atrium was first described by Dr Norbert Ortner in 1987. An extensive literature search revealed only 76 reported cases of Ortner syndrome, with the more recent reports describing other causes of the syndrome such as pulmonary hypertension, aortic dissection, and a thoracic aneurysm. We recently encountered this rare pathologic entity in an elderly man who had presented with severe hoarseness, presumed to be due to one of the aforementioned vascular anomalies. In the present report, we have highlighted the pathology and hybrid repair of this challenging entity.

Keywords: Carotid–carotid bypass; Ortner syndrome; Thoracic aneurysm; Vocal cord paralysis.

Fig 1

A, Computed tomography three-dimensional reconstruction showing a saccular thoracic aneurysm in relation to the aortic arch vessel anatomy. B, Intraoperative angiogram showing saccular thoracic aneurysm filling with contrast.

Fig 2

Intraoperative angiogram after endovascular covered graft placement demonstrating a type 2 endoleak via retrograde flow through the left vertebral artery (arrows) and subsequent perfusion of the left upper extremity.

Fig 3

Artist's depiction of left recurrent laryngeal location and surrounding anatomy.