H Yanardag, Y Karter, M Caner, S Uygun, H Mutlu
H Yanardag, Y Karter, M Caner, S Uygun, H Mutlu. Ortner's Syndrome Associated With Secondary Pulmonary Hypertension. The Internet Journal of Thoracic and Cardiovascular Surgery. 2004 Volume 7 Number 2.
Hoarseness of voice due to paralysis of the left recurrent laryngeal nerve caused by a dilated left atrium in mitral stenosis as discussed by Ortner is a subject of controversy. A variety of cardiac problems such as primary pulmonary hypertension, ischaemic heart disease, hypertension, aortic aneurysm, various congenital heart disorders can all lead to paralysis of the left recurrent laryngeal nerve.We present a case of a 52-year-old woman with hoarseness secondary to the paralysis of the left recurrent laryngeal nerve with severe pulmonary hypertension (mean pulmonary artery pressure of 96 mm Hg, confirmed by cardiac Eco-Doppler ) progressed due to chronic obstructive pulmonary disease (COPD) .
Paralysis of the left recurrent laryngeal nerve causes the horseness of the voice. Paralysis may be due to dilated left atrium in mistral stenosis, ischaemic heart disease, hypertension, aortic aneurysm, various congenital heart disorders like Patent Ductus Arteriosus, and primary pulmonary hypertension.(1,2,3,4,5,6)Also idiopathic dilatation of the pulmonary artery(idiopathic dilatation of the pulmonary trunk) has been recognized for many years as an uncommon condition in which there is enlargement of the main pulmonary artery, with or without dilatation of the right and left pulmonary arteries (7).
A 52 year-old woman presented with progressive exertinal dyspne,cyanosis and coughing with sputum.She has been followed with diagnosis of chronic obstructive pulmonary disease (COPD) for many years and she told that her complaints got worse by the last month. She has never smoked, but she emphisized that she had been a heavy passive smoker. Lung auscultation revealed and prolonged expirium, wheezing and crepitation especially on the basis. The breath frequency was 38/min and blood pressure was 95/70 mmHg . Juguler venous pressure increased. Chest radiography revealed gross dilatation of the right and left pulmonary arteries and amphysematous changes. The right descending pulmonary artery measured 2.8 mm on the chest radiograph; the upper limit of normal is 16 mm (1).The FEV1 value was 29%, arterial blood gas values during the administration of oxygen were as follows: pH, 7.37; PaCO2, 47.7 mmHg; PaO2, 45.7 mm Hg and HCO3, 33 mmol per liter. Computed tomography scanning confirmed the dilated pulmonary arteries (2.8 cm right and left and a pulmoner conus of 3.5 cm) and amphysamatous parenchymal changes. Transthoracic and transoesephageal echocadiography showed the gross dilatation of the right ventricle and high systolic pressure of pulmonary artery (96 mmHg).
The greatly dilated pulmonary artery (main pulmonary artery diameter : 3.5 cm) in this patient resulted in compression of the left recurrent laryngeal nerve and produced an Ortner[apos]s syndrome. The pathogenesis of the vocal cord palsy was documented by cross-sectional computed tomography.
The pulmonary hypertension may progresses seondary to COPD and cause hoarseness due to compression of the recurrent laryngeal nerve. Computed tomography is of great help in differentiating this syndrome from other diseases such as mediastinal mass or lymphadenopathy whenever hoarseness is complicated by pulmonary hypertension..
Prof. Dr. Halil Yanardağ İstanbul Üniversitesi, Cerrahpaşa Tıp Fakültesi, İç Hastalıkları Ana Bilim Dalı, Akciğer Hastalıkları Bölümü Aksaray, İstanbul, TURKEY. Telephone: +90 212 587 90 78 E- mail: firstname.lastname@example.org