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.
- 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.
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
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