Ortner’s syndrome: a case report and literature review

The authors report the case of a 55-year-old female, hypertensive, smoker patient presenting with dysphonia, dysphagia and persistent dry cough. Laryngoscopy diagnosed left vocal cord paralysis. Computed tomography demonstrated saccular aneurysm of the inferior wall of the aortic arch, stretching the left recurrent laryngeal nerve, a finding compatible with Ortner’s syndrome.

Keywords:
Ortner’s syndrome; Aortic arch aneurysm; Recurrent laryngeal nerve; Dysphonia; Dry cough

Authorship

Bruno Landim Dutra Mailing Address: Dr. Bruno Landim Dutra. Serviço de Radiologia e Diagnóstico por Imagem, Hospital Universitário – Centro de Atenção à Saúde, Unidade Dom Bosco. Avenida Eugênio do Nascimento, s/nº, Dom Bosco. Juiz de Fora, MG, Brazil, 36038- 330. E-mail: brunolandim@yahoo.com.br.

MD, Resident, Unit of Radiology and Imaging Diagnosis, Hospital Universitário – Universidade Federal de Juiz de Fora (HU-UFJF), Juiz de Fora, MG, Brazil.Universidade Federal de Juiz de ForaBrazilJuiz de Fora, MG, BrazilMD, Resident, Unit of Radiology and Imaging Diagnosis, Hospital Universitário – Universidade Federal de Juiz de Fora (HU-UFJF), Juiz de Fora, MG, Brazil.

Lenilton da Costa Campos

MDs, Radiologists, Unit of Radiology and Imaging Diagnosis, Hospital Universitário – Universidade Federal de Juiz de Fora (HU-UFJF) and Grupo Alliar, Juiz de Fora, MG, Brazil.Hospital UniversitárioBrazilJuiz de Fora, MG, BrazilMDs, Radiologists, Unit of Radiology and Imaging Diagnosis, Hospital Universitário – Universidade Federal de Juiz de Fora (HU-UFJF) and Grupo Alliar, Juiz de Fora, MG, Brazil.

Hélder de Castro Marques

Vagner Moysés Vilela

MD, Radiologist, Unit of Radiology and Imaging Diagnosis, Hospital Universitário – Universidade Federal de Juiz de Fora (HU-UFJF), Juiz de Fora, MG, Brazil.Universidade Federal de Juiz de ForaBrazilJuiz de Fora, MG, BrazilMD, Radiologist, Unit of Radiology and Imaging Diagnosis, Hospital Universitário – Universidade Federal de Juiz de Fora (HU-UFJF), Juiz de Fora, MG, Brazil.

Rodolfo Elias Diniz da Silva Carvalho

MD, Radiologist at CDM Imagem – Centro de Diagnóstico Médico, and Cedim – Centro Diagnóstico em Medicina, São Mateus, ES, Brazil.Centro Diagnóstico em MedicinaBrazilSão Mateus, ES, BrazilMD, Radiologist at CDM Imagem – Centro de Diagnóstico Médico, and Cedim – Centro Diagnóstico em Medicina, São Mateus, ES, Brazil.

André Geraldo da Silva Duque

MD, Radiologist at Axial Medicina Diagnóstica, Belo Horizonte, MG, Brazil.Axial Medicina DiagnósticaBrazilBelo Horizonte, MG, BrazilMD, Radiologist at Axial Medicina Diagnóstica, Belo Horizonte, MG, Brazil.

Mailing Address: Dr. Bruno Landim Dutra. Serviço de Radiologia e Diagnóstico por Imagem, Hospital Universitário – Centro de Atenção à Saúde, Unidade Dom Bosco. Avenida Eugênio do Nascimento, s/nº, Dom Bosco. Juiz de Fora, MG, Brazil, 36038- 330. E-mail: brunolandim@yahoo.com.br.

SCIMAGO INSTITUTIONS RANKINGS

Figures | Tables

Figures (4)
Tables (1)

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Figure 1
Documentation of videolaryngoscopy and axial CT section (soft tissue window) demonstrating vocal cords asymmetry, with signs of paralysis at left.

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Figure 2
Sagittal oblique reconstruction with the maximum intensity projection technique identifying the aneurysm on the inferior wall of the aortic arch where the recurrent laryngeal nerve usually travels along this vessel.

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Figure 3
Maximum intensity projection, multiplanar reformation obtaining oblique images demonstrating the anatomical relationship between the aortic arch, pulmonary artery trunk and the aneurysm projected on the aortopulmonary window.

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Figure 4
Right and left, anteroposterior and oblique multiplanar reconstructions, utilizing the volume rendering technique, demonstrating focal dilatation of the inferior wall of the aortic arch (arrows).

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Table 1
Differential diagnosis of medial causes of involvement of recurrent laryngeal nerve.

Figure 1 Documentation of videolaryngoscopy and axial CT section (soft tissue window) demonstrating vocal cords asymmetry, with signs of paralysis at left.

Figure 2 Sagittal oblique reconstruction with the maximum intensity projection technique identifying the aneurysm on the inferior wall of the aortic arch where the recurrent laryngeal nerve usually travels along this vessel.

Figure 3 Maximum intensity projection, multiplanar reformation obtaining oblique images demonstrating the anatomical relationship between the aortic arch, pulmonary artery trunk and the aneurysm projected on the aortopulmonary window.

Figure 4 Right and left, anteroposterior and oblique multiplanar reconstructions, utilizing the volume rendering technique, demonstrating focal dilatation of the inferior wall of the aortic arch (arrows).

Table 1 Differential diagnosis of medial causes of involvement of recurrent laryngeal nerve.

Vascular/cardiac	Aortic dissection or pseudoaneurysm, left atrium enlargement, congenital heart diseases, pulmonary artery enlargement, pulmonary embolism
Neoplastic	Bronchogenic carcinoma, lymphoma, esophageal carcinoma, neurogenic tumors (paraganglioma, schwannoma), thyroid carcinoma, malignant thymus disease, lymph node metastasis; retrosternal goiter
Surgical/iatrogenic	Heart surgery, median sternotomy, patent ductus arteriosus ligation or embolization, left lobectomy/pneumomectomy, mediastinoscopy, radical esophagectomy, tracheal resection, thymectomy, thyroidectomy, anterior approach in spine surgeries, carotid endarterectomy, external radiotherapy
Inflammatory	Sarcoidosis, silicosis, fibrosing mediastinitis
Infiltrative	Amyloidosis
Infectious	Tuberculosis, histoplasmosis, coccidioidomycosis, bacterial abscess, mycotic aortic pseudoaneurysm
Traumatic	Deceleration injuries, penetrating chest injuries

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