Thoracic Saccular Aortic Aneurysm Presenting with Recurrent Laryngeal Nerve Palsy prior to Aneurysm Rupture: A Prodrome of Thoracic Aneurysm Rupture?

Masafumi Ohki

doi:10.1155/2012/367873

Abstract

Left recurrent laryngeal nerve palsy rarely results from cardiac disease. We present 2 cases of left recurrent laryngeal nerve palsy caused by thoracic saccular aortic aneurysms. One patient suffered an aortic aneurysm rupture one month after the advent of hoarseness, necessitating emergency surgery with aortic arch replacement. The other patient underwent elective aortic arch replacement surgery. Both saccular aortic aneurysms protruded downward in the aortopulmonary window to compress the recurrent laryngeal nerves. This is only the 5th case report of the rare occurrence of acute recurrent laryngeal nerve palsy subsequent to saccular aneurysm rupture in the English literature. Recurrent laryngeal nerve palsy does not always indicate imminent aneurysm rupture, but should trigger awareness of a potential rupture in the near future. Left recurrent laryngeal nerve palsy might be a prodrome of aneurysm rupture.

Highlights

Hoarseness is rarely caused by cardiovascular diseases
The primary cardiovascular diseases related to recurrent laryngeal nerve palsy are mitral valve disorders, for example, mitral stenosis, cor pulmonale, pulmonary hypertension, aortopulmonary window, Ebstein’s anomaly, aortic aneurysm, aortic dissection, and so on [2, 3]
We experienced 2 rare cases of hoarseness due to left recurrent laryngeal nerve paralysis caused by thoracic saccular aortic aneurysms

Summary

Introduction

Ortner first reported hoarseness due to paralysis of the left recurrent laryngeal nerve caused by a dilated left atrium in mitral stenosis [1]. Recurrent nerve palsy secondary to cardiovascular diseases is called Ortner’s syndrome. The primary cardiovascular diseases related to recurrent laryngeal nerve palsy are mitral valve disorders, for example, mitral stenosis, cor pulmonale, pulmonary hypertension, aortopulmonary window, Ebstein’s anomaly, aortic aneurysm, aortic dissection, and so on [2, 3]. We experienced 2 rare cases of hoarseness due to left recurrent laryngeal nerve paralysis caused by thoracic saccular aortic aneurysms. There are only 4 such case reports of acute recurrent laryngeal nerve palsy with subsequent saccular aneurysm rupture in the English literature [4,5,6,7]. We discuss the features of these cases and our experience

Case Presentation

Discussion

Conclusion

Findings

Conflict of Interests