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