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Cardiovascular System (CVS) ORGAN SYSTEMS

Ortner syndrome

Ortner’s syndrome, also known as cardiovocal syndrome, results from compression of the recurrent laryngeal nerve secondary to benign cardiovascular causes

Ortner’s syndrome, also known as cardiovocal syndrome, results from compression of the recurrent laryngeal nerve secondary to benign cardiovascular causes

In 1897, Norbert Ortner, an Austrian physician described a series of 3 cases of mitral stenosis suffering from hoarseness of voice because of left recurrent laryngeal nerve palsy. He deduced the cause to be compression of the left recurrent laryngeal nerve by an enlarged left atrium. Subsequently, the syndrome has been described in adult patients with various cardiovascular diseases.


Etiology

  • Pulmonary artery enlargement: Primary pulmonary hypertension, recurrent pulmonary emboli and various congenital heart defects
  • Thoracic aortic aneurysms: Usually asymptomatic but present with chest pain when symptomactic. Hoarseness may occur due to compression of the left recurrent laryngeal nerve by the aneurysm, though rare.
Ortner’s syndrome, also known as cardiovocal syndrome, encompasses any cardiac or vascular process that affects the recurrent laryngeal nerve(s), subsequently leading to vocal cord palsy. Various causes of Ortner’s syndrome have been described in the literature, which include but are not limited to aortic aneurysms, pulmonary hypertension, left atrial enlargement, and congenital cardiac disorders. | Joost P. Van Melle, Bart Meyns & Werner Budts (2010) Ortner’s syndrome, presentation of two cases with cardiovocal hoarseness, Acta Cardiologica, 65:6, 703-705, DOI: 10.1080/AC.65.6.2059871

Diagnosis

The diagnostic confirmation includes endoscopic studies of the larynx and skull, neck and chest computed tomography.

CT scan:

The tomographic evaluation is aimed at demonstrating, besides the laryngeal abnormalities, the presence of possible lesions in the course of the vagus and recurrent laryngeal nerves, from the skull base to the aortopulmonary window, corroborating the diagnosis.
  • Thickening and medial positioning of the aryepiglottic fold
  • Increased volume of the piriform sinus and ipsilateral ventricles
  • Anteromedial positioning of the arytenoids cartilage
  • Paramedian position of the vocal cord
  • Coronal plane: Subglottic arch flattening
A well-defined saccular aneurysm, measuring 5.3 cm×3.6 cm, arising from the inferior aspect of the arch of aorta into the aortopulmonary window causing indentation of the left main pulmonary artery (arrow). | Shahul, H. A., Manu, M. K., Mohapatra, A. K., & Magazine, R. (2014). Ortner’s syndrome. BMJ case reports, 2014, bcr2013200950. https://doi.org/10.1136/bcr-2013-200950

Differential diagnosis:

The presentation of the patient is nearly attributed to lung malignancy, primarily due to the similarity in symptoms and abnormal Chest X-ray findings. CECT will help to confirm the diagnosis and rule out other differentials.
  • Lung malignancy

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