Aortic arch aneurysm presenting with Ortner's syndrome: A case report and literature review

Abstract

BackgroundOrtner's syndrome, also known as cardio-vocal cord syndrome, is characterized by vocal cord paralysis secondary to compression of recurrent laryngeal nerve from a cardiopulmonary lesion. Clinicians may fail to diagnose or misdiagnose Ortner's syndrome because of its low incidence and complex pathogenesis. Here, we report a patient with an aortic arch aneurysm presenting solely with vocal cord paralysis and review existing literature to better understand Ortner's syndrome pathogenesis. Case presentationOn August 23, 2021, a 74-year-old man with cholecystolithiasis and acute cholecystitis was admitted to the Department of Hepatobiliary Surgery, at the First Affiliated Hospital of Jinan University. During medical history collection and physical examination, the patient's voice was unexpectedly hoarse. The patient then underwent laryngoscopy, computed tomography (CT) scanning of the chest, and enhanced CT scanning. Three-dimensional reconstruction of the thoracic aorta revealed an unstable aneurysm at the anterior of the aortic arch. The left recurrent laryngeal nerve was compressed by the aneurysm, leading to left vocal cord paralysis and voice hoarseness. DiscussionHoarseness caused by vocal cord paralysis suggests damage to the recurrent laryngeal nerve. Examination based on the anatomical path, from the base of the skull to the diaphragm, especially from the vagus nerve origin area to the end of the recurrent laryngeal nerve, is helpful for early diagnosis of neck and thoracic cavity disorders, which could prevent misdiagnosis of acute and critical diseases.