Presentation
Hoarseness of voice.
Patient Data
Medialization of the left vocal cord with medial displacement of the left arytenoid cartilage and widening of the left pyriform fossa. Relative thickening of the ipsilateral aryepiglottic fold. No definite masses.
Scans through the upper chest show markedly enlarged left atrium measuring 13 cm in maximum diameter splaying the carina.
Case Discussion
Features of left vocal cord paralysis mostly secondary to left recurrent laryngeal nerve compression by the enlarged left atrium. In the presence of vocal cord paralysis, a cause can be identified along the course of the recurrent laryngeal nerves from the origin in the brainstem, through the neck, and should always include the superior mediastinum.
Ortner syndrome (cardiovocal syndrome) is characterized by hoarse voice resulting from left recurrent laryngeal nerve palsy secondary to a cardiovascular disorder. The historical description of Ortner syndrome is due to a markedly distended left atrium secondary to mitral stenosis which has a reported incidence of 1.5% to 6%. Other cardiovascular diseases may also cause left recurrent laryngeal nerve compression like thoracic aortic aneurysm, enlarged pulmonary artery and aberrant subclavian artery syndrome.
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