Ortner's syndrome: Hoarseness of voice revealing severe secondary pulmonary hypertension

Abstract

Ortner's syndrome or cardiovocal syndrome is a rare condition referring to laryngeal recurrent nerve paralysis due to cardiovascular conditions. We report the case of a 66-year-old man, with a medical history of active smoking, who complained of hoarseness of voice secondary to vocal cord palsy. A neck and thoracic CT scan revealed severe enlargement of pulmonary main artery, which caused compression of the left recurrent laryngeal nerve in the aortopulmonary window. The prolonged course of the left laryngeal nerve makes it susceptible to injury from cardiovascular structures in the mediastinum. Consequently, cardiovascular conditions such as dilated pulmonary artery or an aneurysm of the aortic arch can compress the nerve, resulting in Ortner's syndrome.

Keywords: Cardiovocal syndrome; Hoarseness; Ortner's syndrome; Pulmonary hypertension.

Fig. 1

Cervical axial CT images showing features of left vocal cord paralysis. (A) Thickening and medial deviation of the left aryepiglottic fold (red arrow) with enlargement of the ipsilateral pyriform sinus (white asterisk). (B) Abducted left vocal cord (yellow arrow) with compensatory bowing of the contralateral vocal cord (arrow head), and enlargement of the left laryngeal ventricle realizing the “sail sign” (red asterisk).

Fig. 2

Thoracic CT angiography demonstrating important enlargement of the pulmonary trunk measuring 55 mm, compared to the aortic diameter of 31 mm, compressing on the aortic arch and the aortopulmonary window (red arrow).