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, 2012, 230736

Cardiovocal Syndrome (Ortner's Syndrome) Associated With Chronic Thromboembolic Pulmonary Hypertension and Giant Pulmonary Artery Aneurysm: Case Report and Review of the Literature

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Cardiovocal Syndrome (Ortner's Syndrome) Associated With Chronic Thromboembolic Pulmonary Hypertension and Giant Pulmonary Artery Aneurysm: Case Report and Review of the Literature

Jaakko Heikkinen et al. Case Rep Med.

Abstract

Cardiovocal syndrome or Ortner's syndrome is hoarseness due to left recurrent laryngeal nerve palsy caused by mechanical affection of the nerve from enlarged cardiovascular structures. Chronic thromboembolic pulmonary hypertension is extremely rarely found to cause this syndrome. We describe a case of a 56-year-old patient with sudden onset of hoarseness. The patient had known long standing severe pulmonary hypertension. Fiberoptic laryngoscopy showed left vocal cord palsy. Computed tomography of the neck and chest revealed extensive enlargement of the pulmonary arteries and excluded a malignant tumor. The diagnosis of cardiovocal syndrome was retained. It is important for the radiologist to be aware of this possible etiology causing left recurrent laryngeal nerve palsy and to understand its mechanism.

Figures

Figure 1
Figure 1
56-year-old male with chronic thromboembolic pulmonary hypertension and sudden hoarseness. Appearance of the paralysed left vocal cord (white arrow) during fiberoptic laryngoscopy, no malignant lesion was detected in this examination.
Figure 2
Figure 2
Chest radiographs ((a) and (b)) from 2012 showed severe dilatation of both pulmonary arteries (arrows). (R = right pulmonary artery).
Figure 3
Figure 3
Chest CT featured the signs of pulmonary arterial hypertension, pulmonary trunk (PT) dilatation, aneurysmal dilatation of the central pulmonary arteries (PA), wall-adherent thrombotic material in pulmonary arteries (asterix), right ventricular hypertrophy (white arrow in (d)). No mass lesion or lymphadenopathy was found and the radiologist suggested the cardiovocal syndrome as a possible diagnosis because of the obvious mass effect caused by the dilated central pulmonary arteries. The possible compression of the left recurrent laryngeal nerve between the aorta and pulmonary artery is well appreciated (black arrow in (a)).
Figure 4
Figure 4
Coronal (a) and sagittal reformat (b) from the CT. The aortopulmonary window (arrow in (a)) is almost completely obstructed by the enlarged left pulmonary artery. (b) The sagittal reformat demonstrates the narrow space between the aorta (A) and pulmonary artery (PA).

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Cited by 5 PubMed Central articles

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