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Weekly Chest CasesArchive of Old Cases

Case No : 988 Date 2016-10-03

  • Courtesy of Min Ah Lee, Sun Young Jeong / Jeju National University Hospital
  • Age/Sex 60 / M
  • Chief ComplaintHoarseness (onset: two months ago)
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Ortner's Syndrome
Radiologic Findings
Chest radiograph shows a well-defined bulging soft tissue lesion in the left suprahilar area.
Neck CT demonstrates left vocal cord palsy.
CT angiography of the aorta reveals a saccular aneurysm with mural thrombus at the left lateral aspect of the aortic arch.
Brief Review
Ortner's Syndrome is a rare clinical entity, first described in 1897. It describes left recurrent laryngeal nerve palsy resulting from identifiable cardiovascular disease.
Left recurrent laryngeal nerve arises from the vagus nerve on the left side of the aortic arch. 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 for this reason it is also known as cardiovocal syndrome. Various underlying causes include left ventricular failure, atrial septal defect, Eisenmenger syndrome, mitral valve prolapse, primary pulmonary hypertension, aortic aneurysm, and aortic dissection.

References
1. IC Bickle, BE Kelly, DS Brooker. Ortner's syndrome: a radiological diagnosis. The Ulster Medical Journal. 2002;71:55-56.
2. John Mathai, Swapna UP. Hoarseness : as a presenting feature of aortic arch aneurysm. Indian Journal of Otolaryngology and Head and Neck Surgery. 2006; 58(3):309-310.
3. 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.
4. Annema JT et al. A rare cause of Ortner’s syndrome (cardiovocal hoarseness). Thorax. 2004;59(7):6361.


Keywords
Airway, Vascular, Vascular, left recurrent laryngeal nerve palsy secondary to cardiac disease,

No. of Applicants : 95

▶ Correct Answer : 54/95,  56.8%
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Northern Yokohama Showa university , Japan Kota Watanabe
  • - Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - King Abdulaziz University Hospital , Saudi Arabia Amr Ajlan
  • - Shanghai Jiao Tong University Affiliated Sixth People萸 , China Jiayin Zhang
  • - , Korea (South)
  • - Eren Hastanesi Istanbul , Turkey Armagan Sarac
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Ajou university hospital , Korea (South) Pae Sun Suh
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Kyungpook national university , Korea (South) Chungeun Lim
  • - Nasaret Hospital , Korea (South) Hee Seok Choi
  • - Scans world , India Philson Mukkada
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - �stanbul , Turkey Ayhan Yilmaz
  • - The Jikei university , Japan Taku Gomi
  • - university of montreal , Canada Andrei Gorgos I
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - , Korea (South) BAEK YOOLIM
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - Seoul National University Hospital , Korea (South) Hyoung-In Choi
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Department of Radiology, Seoul National University Bundang Hospital , Korea (South) Sung Hyun Yoon
  • - Narayana Multispeciality Hospital Jaipur Raj , India JAINENDRA JAIN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - SNUH , Korea (South) TAE HYUNG KIM
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Han Na Lee
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - University of Toronto , Canada Micheal McInnis
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - University of Tsukuba, Dept of Radiology , Japan Manabu Minami
  • - Samsung Medical Center , Korea (South) Boda Nam
  • - Maimonides Medical Center , United States naomi twersky
  • - Ajou university hospital , Korea (South)
  • - Seoul national university hospital , Korea (South) Kumju Chae
  • - GHICL , France manuel toledano
  • - Red Cross Society Himeji Hospital , Japan Soichiro Okamoto
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu chong
  • - MBAL BURGAS , Bulgaria VLADISLAV RUSINOV
  • - sunder lal jain hospital , India sanjeev vachher
  • - Korea university medical center, guro hospital , Korea (South) JINWOO HAN
  • - Ajou University Hospital , Korea (South) Seulgi You
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Seoul National University Hospital , Korea (South) Sunkyung Jeon
  • - Asan medical center , Korea (South) Seung Yeon Noh
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Korea University Guro Hospital , Korea (South) Jeong Woo Kim
  • - Private sector , Greece Vasilios Tzilas
  • - SNUH , Korea (South) Juil Park
  • - Kyoto University , Japan Akihiko Sakata
  • - Korea University Guro Hospital , Korea (South) Hwanseok Yong
  • - Chonnam national university hospital , Korea (South) Lee Bin
▶ Correct Answer as Differential Diagnosis : 1/95,  1.1%
  • - Saitama-Sekishinkai Hosptal , Japan Mihoko Yamazaki
▶ Semi-Correct Answer : 31/95,  32.6%
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan Tomoaki Otani
  • - Osaka Rosai Hospital , Japan Hiromitsu Sumikawa
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - nizam , India Amit Dadhania
  • - Kizawa Memorial Hospital , Japan Tomohiro Ando
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - PRINCE ALI KHAN HOSPITAL , India FAHAD LODHIA
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Qatif Central Hospital , Saudi Arabia Hani Alsalam
  • - 異⑸ , Korea (South) 蹂€
  • - Chungbuk national university , Korea (South) Yong Kim
  • - Medicheck health care , Korea (South) Chae Lim
  • - chungbuk national university hospital , Korea (South) lee jung hwan
  • - University of Tsukuba Hospital , Japan Hiroaki Takahashi
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Avrasya Hospital , Turkey Murat Ulusoy
  • - Chungbuk national university hospital , Korea (South) Miran Yeon
  • - 以‘ , Korea (South) Jang Won
  • - christian medical college , India Prateek Malik
  • - Kanto Rosai Hospital , Japan Taku Tajima
  • - Aerospace medical group, Air Force Education and Training Command , Korea (South) Donghwan Kim
  • - NASA SCANS , India RAKESH BHATIA
  • - Maternity & child hospital , Saudi Arabia Sania ALBlushi
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - ROKAF 10th Fighter Wing , Korea (South) Kun Woo Kang
  • - The University of Tokyo Hospital , Japan Kaoru Sumida
  • - University of Tsukuba , Japan Toshitaka Ishiguro
  • - 異⑸ , Korea (South) 瑜˜
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