Ortner's syndrome presenting as thoracic aortic aneurysm mimicking thoracic malignancy: a case report

Ortner's syndrome: A systematic review of presentation, diagnosis and management

Ortner's syndrome (OS), also called cardiovocal syndrome, is a rare condition hallmarked by left recurrent laryngeal nerve palsy due to underlying cardiopulmonary disease. The purpose of this review is to systemically analyze the existing literature for cases of OS to outline typical presentation, methods of diagnosis, and management of these patients. Case reports, case series, and cohort studies describing OS between 1955 and 2021 were identified. Individual manuscripts were reviewed for clinical features, presentation, and management. A total of 117 patient cases were gathered from 92 published articles. Common symptoms included hoarseness, dyspnea, cough, and dysphagia. The most common associated comorbidity was aortic aneurysm (41%), followed by pulmonary hypertension (35%), mitral stenosis (17%), and hypertension (12%). Among those who were managed via surgical intervention, 85.4% reported improvement in their hoarseness. While historically OS was associated with mitral stenosis, in recent decades, aortic aneurysms and dilation of the pulmonary artery from pulmonary hypertension have emerged as primary etiologies of OS. Therefore, OS should be considered in any patient presenting with hoarseness and history of cardiopulmonary disease. Surgical intervention in appropriate candidates resolves OS in most cases.

Cardiovocal Syndrome Secondary to Thoracic Aortic Aneurysm: An Old Sign Revisited

A 56-year-old male, chronic smoker, presented with persistent dry cough, hoarseness of voice and difficulty in swallowing. Indirect laryngoscopy revealed left vocal cord paralysis. Further evaluation revealed eccentric saccular aneurysms arising from the aortic arch and descending thoracic aorta, compressing the trachea, esophagus, left atrium and left recurrent laryngeal nerve. The patient was diagnosed with Ortner's syndrome which is an uncommon presentation of aortic aneurysm. He awaits an endovascular aorta aneurysm repair.