Ortner’s syndrome in interdisciplinary collaboration
Authors:
Ivan Kalivoda 1; Jakub Konečný 2
Authors‘ workplace:
Oddělení otorinolaryngologie a chirurgie hlavy a krku, Nemocnice AGEL Nový Jičín, a. s.
1; Kardiochirurgická klinika LF OU a FN Olomouc
2
Published in:
Čas. Lék. čes. 2024; 163: 236-239
Category:
Case Report
Overview
Ortner’s syndrome, also known as cardiovocal syndrome, is a rare cause of hoarseness due to compression of the left recurrent laryngeal nerve caused by pathology of cardiovascular structures in the mediastinum. It was first described by Norbert Ortner in 1897, who associated the syndrome with mitral stenosis. It typically presents as paresis of the left recurrent laryngeal nerve, which is mechanically compressed in the area of the aortic arch.
The case report describes an 81-year-old non-smoker who was examined for two months of hoarseness. Laryngoscopic examination revealed paralysis of the left vocal cord, and CT of the neck and mediastinum with contrast showed ectasia of the ascending aorta and aneurysm of the aortic arch. The patient was consulted by both a cardiothoracic surgeon and an interventional radiologist, but due to his age and the incidental nature of the finding, neither surgical nor endovascular treatment was recommended. The patient was discharged home, where he later passed away surrounded by his family.
The prognosis of these patients depends on prompt diagnosis and treatment. Early intervention can improve or restore vocal function. Regular monitoring and interdisciplinary collaboration are also crucial factors for optimal patient care.
Keywords:
Ortner’s syndrome, vocal cord paresis, aneurysm, aortal arch
Sources
- Ortner N. Recurrensläahmung bei Mitralstenose. Wien Klin Wochenschr 1897; 10: 753–755.
- Fetterolf G, Norris G. The anatomical explanation of paralysis of left recurrent laryngeal nerve found in certain case of mitral stenosis. Am J Med Sci 1911; 141: 625–638.
- Leoce BM, Bernik JT, Voigt B et al. Ortner syndrome secondary to saccular thoracic aneurysm. J Vasc Surg Cases Innov Tech 2021; 7: 371–373.
- Acharya MN, Bahrami T, Popov AF et al. Rapid resolution of Ortner’s syndrome with giant left atrium after double-valve replacement surgery. Interact Cardiovasc Thorac Surg 2017; 25: 663–664.
- Goropse L, Fernández-Méndez MA, Ayala-Carbonero AM et al. Ortner’s syndrome secondary to huge left atrium. Ann Thorac Surg 2015; 100: 732.
- Al Kindi AH, Al Kindi FA, Al Abri QS et al. Ortner’s syndrome: cardiovocal syndrome caused by aortic arch pseudoaneurysm. J Saudi Heart Assoc 2016; 28: 266–269.
- Zaharudin I, Azizi ZA. Thoracic aortic aneurysm as a cause of Ortner’s syndrome: a case series. Med J Malaysia 2016; 71: 139–141.
- Lydakis C, Thalassinos E, Apostolakis S et al. Hoarseness as imminent symptom of aortic aneurysm rupture (Ortner’s syndrome). Int Angiol 2006; 25: 231–233.
- Arango Guerra P, Ortega-Agamez C, Naranjo-Restrepo S. Ortner’s syndrome (cardiovocal syndrome): a case report. Cureus 2023; 15: e38408.
- Loughran S, Alves C, MacGregor F B. Current aetiology of unilateral vocal fold paralysis in a teaching hospital in the West of Scotland. J Laryngol Otol 2002; 116: 907–910.
- Mulpuru SK, Vasavada BC, Punukollu GK et al. Cardiovocal syndrome: a systematic review. Heart Lung Circ 2008; 17: 1–4.
- Shahul HA, Manu MK, Mohapatra AK et al. Ortner’s Syndrome. BMJ Case Rep 2014; bcr2013200950.
- Paquette CM, Manos DC, Psooy BJ. Unilateral vocal cord paralysis: a review of CT findings mediastinal causes and the course of the recurrent laryngeal nerves. Radiographics 2012; 32: 721–740.
- Zhang Z, Feng H, Chen X et al. Ortner’s syndrome secondary to thoracic aortic aneurysm: a case series. J Cardiothorac Surg 2022; 17: 270.
- Ismazizi Z, Zainal AA. Thoracic aortic aneurysm as a cause of Ortner’s syndrome – a case series. Med J Malaysia 2016; 71: 139–141.
- Teixido MT, Leonetti JP. Recurrent laryngeal nerve paralysis associated with thoracic aortic aneurysm. Otolaryngol Head Neck Surg 1990; 102: 140–144.
- Stone DH, Brewster DC, Kwolek CJ et al. Stent-graft versus open-surgical repair of the thoracic aorta: mid-term results. J Vasc Surg 2006; 44: 1188–97.
- Zhu J, Zhao L, Dai X, et al. Fenestrated thoracic endovascular aortic repair using physician modified stent grafts for acute type B aortic dissection with unfavourable landing zone. Eur J Endovasc Surg 2018; 55: 170–176.
- Coselli JS, Conklin LD, LeMaire SA. Thoracoabdominal aortic aneurysm repair: review and update of current strategies. Ann Thorac Surg 2002; 74: S1881–S1884.
- Madhuraj S, Gangadharan H, Manju R et al. A rare cause of Ortner’s syndrome and a case-based review of literature. Indian J Otolaryngol Head Neck Surg 2022; 74: S5338–S5341.
- Hartl DM, Travagli JP, Leboulleux S et al. Clinical review: current concepts in the management of unilateral recurrent laryngeal nerve paralysis after thyroid surgery. J Clin Endocrinol Metab 2005; 90: 3084–3088.
- Verma S, Talwar A, Khan S et al. Ortner’s syndrome: a systematic review of presentation, diagnosis and management. Intractable Rare Dis Res 2023; 12: 141–147.
- Pathirana U, Kularatne S, Handagala S et al. Ortner’s syndrome presenting as thoracic aortic aneurysm mimicking thoracic malignancy: a case report. J Med Case Reports 2015; 9: 147.
- Österreichischen Akademie der Wissenschaften. (Hg.). Österreichisches biographisches Lexikon. Band VIII: Pet–Raz. Verlag der Österreichischen Akademie der Wissenschaften, Wien, 1978.
- Fischer I. (Hg.). Biographisches Lexikon der hervorragenden Ärzte der letzten fünfzig Jahre. Band 2: Kon–Zweig. Urban & Schwarzenberg, Berlin, Wien, 1933.
- Lesky E. Die Wiener medizinische Schule im 19. Jahrhundert. Verlag Hermann Böhlaus Nachfolger, Wien 1965.
- Czeike F. Historisches Lexikon Wien. Band 4, Le–Ro. Verlag Kremayr & Scheriau, Wien 1995
- Regal W, Nantut M. Wenn Tote länger leben sollen (Narrenturm 92). Ärzte Woche, 2007 Mar 3. Dostupné na: https://web.archive.org/web/20131203230329/http://www.springermedizin.at/artikel/8325-wenn-tote-laenger-leben-sollen-narrenturm-92
Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental HygienistArticle was published in
Journal of Czech Physicians
Most read in this issue
- Injury of the popliteal artery by shrapnel of a Ukrainian girl treated at the University Hospital Ostrava - case report of arterial lesion without acute limb ischemia
- Modern approaches in multidisciplinary treatment of cleft lip and palate
- Ancient sanctuary of Asclepius, god of medicine, on the island of Paros (Greece)
- Bedřich Smetana’s hearing loss could be caused by chronic mercury intoxication