Hoarseness of Voice as a Primary Presentation of Pulmonary Hypertension: a Rare case of Ortner’s (Cardio-vocal) Syndrome

Abstract

Enlargement of cardiovascular structures can frequently affect the left (unlike right) recurrent laryngeal nerve and cause left vocal cord paralysis as patients present with hoarseness of voice. This disease entity has been named as Ortner's syndrome after the name of the physician who first described it. It presents a diagnostic challenge in the absence of significant cardiac symptoms. We report a young girl who is diagnosed with this condition and present the related literature.A 20-year-old lady was referred from primary health center due to complaints of hoarseness of voice for the last four months. She reported only mild exertional palpitations and shortness of breath. She did not report any previous cardiac problem in childhood. Examination revealed a loud pulmonary component of 2nd heart sound, a pan-systolic murmur at the tricuspid area, and a palpable thrill. There was no evidence of right heart failure or any stigmata of connective tissue disease. Electrocardiography showed sinus rhythm with dominant R-wave in lead V1 indicating right ventricular hypertrophy. Laboratory tests did not reveal any abnormality.ISSN: 2410-2636 © Barcaray Publishing * Corresponding author. E-mail: kbncardiology@yahoo.co.uk AbstractOrtner's (cardio-vocal) syndrome is a rare disease entity that involves compression of the left recurrent laryngeal nerve due to enlargement of cardiovascular structures. The syndrome was first described by Norbert Ortner (an Austrian physician) in 1897 and is usually reported to be associated with mitral stenosis. However, we report a rare case when a 20-year-old girl presented with hoarseness of voice and was found to have an enlarged main pulmonary trunk due to pulmonary hypertension that was compressing the left recurrent laryngeal nerve. The case highlights a rare presentation of a relatively common disease and stresses the importance of detailed cardiac workup in a patient with hoarseness of voice. We present the case and review the literature. Key words:Ortner's syndrome, Pulmonary hypertension, Vocal cord palsy. Citation:Bin Naeem K., and Choondal V. Computerised tomography of the chest indicating severely dilated main pulmonary trunk (42 mm) with no evidence of pulmonary embolism.

Isolated vocal cord palsy secondary to a paraoesophageal hiatus hernia: a rare variant of Ortner’s syndrome

“…It was first described by Ortner, an Austrian physician, who correlated left vocal cord palsy in 3 patients with left atrial enlargement secondary to mitral stenosis 2. Most cases of Ortner’s syndrome are due to left recurrent laryngeal nerve compression between the aorta and pulmonary artery in the aortopulmonary window 3. Variations of Ortner’s syndrome have also been described in patients with thoracic aortic aneurysm, enlarged pulmonary artery and aberrant subclavian artery 4.…”