Archive of Old Cases
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- Archive of Old Cases
- 2007
Case No : 482 Date 2007-01-22
- Courtesy of Sun Mi Kim, MD, Seong Hoon Park, MD, Kyung-Hyun Do / Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- Age/Sex 56 / M
- Chief ComplaintHoarseness (onset; one month ago)
Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Ortner's Syndrome (Cardiovocal Syndrome)
- Radiologic Findings
- Plain chest radiograph shows bulging contour-soft tissue lesion at left suprahilar area. Neck CT shows left vocal cord palsy. Chest CT shows two saccular aneurysms at isthmic portion of aortic arch.
- Brief Review
- Definition: Clinical entities manifested by hoarseness due to left recurrent laryngeal nerve palsy secondary to cardiac disease.
The left vagus nerve at the level of the aortic arch gives rise to the left recurrent laryngeal nerve. This nerve curves beneath the aorta on the outer side of ligamentum arteriosum and ascends to the groove between the esophagus and the trachea. It continues along this groove to supply all the muscles acting on the left vocal cord, except the cricothyroid muscle, which is innervated by the superior laryngeal nerve. In this syndrome, the left recurrent laryngeal nerve is thought to be injured due to compression caused by changes in the anatomy of the heart or great vessels. Cardiovascular disease is an unusual cause of vocal cord palsy, and this clinical entity is called cardiovocal syndrome. These causes include left ventricular failure, an atrial septal defect, Eisenmenger syndrome, mitral valve prolapse, primary pulmonary hypertension, an aortic aneurysm, and an aortic dissection. - References
- 1. Lee SI, Pyun SB, Jang DH. Disphagia and hoarseness associated with painless aortic dissection: A rare case of cardiovocal syndrome. Dysogagua. 2006;21(2):129-132.
2. Annema JT et al. A rare cause of Ortner’s syndrome (cardiovocal hoarseness). Thorax. 2004;59(7):6361. Yoon YC, Lee KS, Kim TS et al. Intrapulmonary bronchogenic cyst: CT and pathologic findings in five adult patients AJR 2002;179:167-170 - Keywords
- Airway, Vascular, Vascular, left recurrent laryngeal nerve palsy secondary to cardiac disease,
No. of Applicants : 32
- ▶ Correct Answer : 2/32, 6.3%
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- - China Medical University Hospital,Taiwan Jun-Jun Yeh
- - Ultra Care, Coimbatore, India Debabrata Das
- ▶ Correct Answer as Differential Diagnosis : 1/32, 3.1%
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- - Annecy Hospital, France Gilles Genin
- ▶ Semi-Correct Answer : 11/32, 34.4%
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- - Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
- - Hopital Calmette. Chru Lille, France Toledano Manuel
- - Zulekha Hospital, Dubai Saurabh Khandelwal
- - Zulekha Hospital, Dubai Julie Arora
- - Kunyang University Hospital, Korea Ho Jun Kim
- - Nirman Hi-Tech Diagnostic Centre, Mumbai, India Minal Seth
- - Nirman Diag Centre, Mumbai, India Padma
- - Nassau, Bahamas Trupti Dabholkar
- - Yonsei University, Severance Hospital, Korea Hye Mi Kim
- - E-DA Hospital, Taiwan Yu-Feng Wei
- - Doctors Hospital, Nassau, Bahamas N.B.S.Mani
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