medigraphic.com
Anales de Otorrinolaringología Mexicana

2023, Number 3

<< Back Next >>

Otorrinolaringología 2023; 68 (3)

Cardiovocal syndrome (Ortner’s syndrome) associated with pulmonary hypertension

Gutiérrez ECA, Morán CP, Acosta FMA, Wong AR

Language: Spanish
References: 28
Page: 156-162
PDF size: 348.50 Kb.


ABSTRACT

Background: Cardiovocal syndrome, or Ortner’s syndrome, is a group of signs and symptoms caused by mechanical compression of left recurrent laryngeal nerve. The principal symptom is hoarseness, due to left recurrent laryngeal nerve palsy. Any cardiovascular abnormality that compresses the recurrent laryngeal nerve within the aortopulmonary window, which can be as narrow as 4 mm according to cadaveric studies, can cause Ortner’s syndrome. Pulmonary hypertension is a chronic and progressive disease in which the pressure levels of the pulmonary circulation are elevated (› 25 mmHg). It could be idiopathic or arise in the context of other clinic diseases. Dilation of pulmonary artery can condition compression of recurrent laryngeal nerve and cause dysphonia, being a rare presentation of cardiovocal syndrome.
Clinical case: An 85-year-old male patient with dysphonia secondary to palsy of the left recurrent laryngeal nerve in the context of tomographic data suggestive of pulmonary hypertension causing nerve compression.
Conclusions: It is important to consider cardiac causes of dysphonia, as well as early recognition and treatment, along with elimination of the underlying cause, if possible, as these can change the patient’s quality of life and prognosis.


REFERENCES

  1. Nambiar R, Dalus D, Srikumar A. Cardiovocal syndrome:A rare cause of hoarseness in a patient with a history ofpulmonary tuberculosis. Sultan Qaboos Univ Med J 2017;17 (4): e481-3. doi: 10.18295/squmj.2017.17.04.019.

  2. Song SW, Jun BC, Cho KJ, Lee S, Kim YJ, Park SH. CT evaluationof vocal cord paralysis due to thoracic diseases: A10-year retrospective study. Yonsei Med J 2011; 52 (5):831-7. doi: 10.3349/ymj.2011.52.5.831.

  3. Heikkinen J, Milger K, Alejandre-Lafont E, Woitzik C, LitzlbauerD, Vogt JF, et al. Cardiovocal syndrome (Ortner’ssyndrome) associated with chronic thromboembolicpulmonary hypertension and giant pulmonary artery aneurysm:Case report and review of the literature. Case RepMed 2012; 2012. doi: 10.1155/2012/230736.

  4. Shankar O, Lohiya BV. Cardiovocal syndrome - A rarepresentation of primary pulmonary hypertension. IndianHeart J 2014; 66 (3): 375-7. doi: 10.1016/j.ihj.2013.12.055.

  5. Heikkinen J, Milger K, Alejandre-Lafont E, Woitzik C,Litzlbauer D, Vogt J-F, et al. Cardiovocal syndrome(Ortner’s syndrome) associated with chronic thromboembolicpulmonary hypertension and giant pulmonaryartery aneurysm: case report and review of the literature.Case Rep Med 2012; 2012: 230736. https://doi.org/10.1155/2012/230736.

  6. Rojas M, Quijano Y, Luque Bernal RM. Recurrent laryngealnerve in a sample of the Colombian population. Rev FacMed 2016; 64 (2): 207-13. https://doi.org/10.15446/revfacmed.v64n2.50643.

  7. Benouaich V, Porterie J, Bouali O, Moscovici J, Lopez R.Anatomical basis of the risk of injury to the right laryngealrecurrent nerve during thoracic surgery. Surg Radiol Anat2012; 34 (6): 509-12. https://doi.org/10.1007/s00276-012-0946-7.

  8. Tang W-J, Sun S-Q, Wang X-L, Sun Y-X, Huang H-X. An appliedanatomical study on the recurrent laryngeal nerveand inferior thyroid artery. Surg Radiol Anat 2012; 34 (4):325-32. https://doi.org/10.1007/s00276-011-0905-8.

  9. Chen RF, Lin CT, Lu CH. Ortner’s syndrome - A rare causeof unilateral vocal cord paralysis: A case report. KaohsiungJ Med Sci 2009; 25 (4): 203-6. http://dx.doi.org/10.1016/S1607-551X(09)70061-0.

  10. Frost A, Badesch D, Gibbs JSR, Gopalan D, Khanna D, ManesA, et al. Diagnosis of pulmonary hypertension. Eur Respir J2019; 53 (1): 1801904. doi: 10.1183/13993003.01904-2018.

  11. Hoeper MM, Ghofrani H-A, Grünig E, Klose H, OlschewskiH, Rosenkranz S. Pulmonary hypertension. Dtsch ArzteblInt 2017; 114 (5): 73-84.

  12. Elizondo-Azuela R, Vizcaíno-Alarcón A. Síndrome cardiovocal(síndrome de Ortner) en un paciente de 16 meses deedad, secundario a un conducto arterioso permeable. In:Ana Otorrinolaringol Mex 2015: 200-6.

  13. Shah KD, Ayyer KH, Shah UK. Hoarseness of voice—Apresenting manifestation of primary pulmonary hypertension.Indian J Otolaryngol 1980; 32 (2): 35-6. https://doi.org/10.1007/BF02992139.

  14. Nakao M, Sawayama T, Samukawa M, Mitake H, Nezuo S,Fuseno H, et al. Left recurrent laryngeal nerve palsy associatedwith primary pulmonary hypertension and patentductus arteriosus. J Am Coll Cardiol 1985; 5 (3): 788-92.doi: 10.1016/s0735-1097(85)80413-7.

  15. Kheok SW, Salkade PR, Bangaragiri A, Koh NSY, Chen RC.Cardiovascular hoarseness (Ortner’s syndrome): A pictorialreview. Curr Probl Diagn Radiol 2021; 50 (5): 749-54.https://doi.org/10.1067/j.cpradiol.2020.09.015.

  16. Ohi K, Suzuki J, Ikeda R, Kakuta R, Katori Y. Cardiovocalsyndrome associated with idiopathic pulmonary arterialhypertension: a case report and literature review. Cureus2022; 14 (7): e27070. doi:10.7759/cureus.27070.

  17. Aluja Jaramillo F, Gutierrez FR, Díaz Telli FG, Yevenes AravenaS, Javidan-Nejad C, Bhalla S. Approach to pulmonary hypertension:From CT to clinical diagnosis. Radiographics 2018;38 (2): 357-73. https://doi.org/10.1148/rg.2018170046.

  18. Brinton WD. Primary pulmonary hypertension. Br Heart J

  19. 1950; 12 (3): 305. doi: 10.1136/hrt.12.3.305.19. Soothill JF. A case of primary pulmonary hypertensionwith paralysed left vocal cord. Guys Hosp Rep 1951; 100(3): 232-7.

  20. Kagal AE, Shenoy PN, Nair KG. Ortner’s syndrome associatedwith primary pulmonary hypertension. J PostgradMed 1975; 21 (2): 91-5.

  21. Shah KD, Shah UK. Hoarseness--a presenting manifestationof primary pulmonary hypertension. Indian Heart J1975; 27 (2): 105.

  22. Wilmshurst PT, Webb Peploe MM, Corker RJ. Left recurrentlaryngeal nerve palsy associated with primary pulmonaryhypertension and recurrent pulmonary embolism. Br HeartJ 1983; 49 (2): 141. doi: 10.1136/hrt.49.2.141.

  23. Sengupta A, Dubey SP, Chaudhuri D, Sinha AK, ChakravartiP. Ortner’s syndrome revisited. J Laryngol Otol 1998; 112(4): 377-9. doi: 10.1017/s0022215100140514.

  24. Rajasekhar P, Ramarao P, Bingi P, Pani C. A rare case of primarypulmonary hypertension with cardiovocal syndrome.Indian J Appl Res 2014; 4 (9): 407-9. doi: 10.36106/IJAR.

  25. Dakkak W, Tonelli AR. Compression of adjacent anatomicalstructures by pulmonary artery dilation. Postgrad Med2016; 128 (5): 451-9. https://doi.org/10.1080/00325481.2016.1157442.

  26. Garg R, Singh A, Sawlani KK, Mishra AK. Hoarseness ofvoice as presenting complaint of idiopathic pulmonaryarterial hypertension. Lung India 2017; 34 (2): 212.doi: 10.4103/0970-2113.201304.

  27. Kardos M, Macaj M, Kaldararova M, Masura J. Hoarsevoice, first symptom of severe pulmonary hypertension.Int J Pediatr Otorhinolaryngol Extra 2017; 16: 4-6. https://doi.org/10.1016/j.pedex.2016.12.002.

  28. Jalil BA, Smith JS, El-Kersh K. A 34-year-old womanwith hoarseness of voice and an abnormal echocardiogram.Chest 2019; 155 (6): e163-6. doi: 10.1016/j.chest.2019.01.021.




2020     |     www.medigraphic.com