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Cases
A Little Hoarse
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Background
A 61-year-old woman presents to the hospital with a change in her voice. Laryngoscopy reveals complete vocal cord paralysis on the left side. Her past medical history is significant for hypertrophic obstructive cardiomyopathy (HOCM). She has an implantable cardiac defibrillator in place. Imaging studies of the thorax reveal the cause of the problem.
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Scroll
down for Hint and Answer
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***** HINT *****
Take a look through the aortopulmonary (AP) window.
***** ANSWER *****
Ortner syndrome (cardiovocal syndrome): The left recurrent laryngeal nerve branches off the vagus nerve in the superior mediastinum. It then dives under the aorta posterior to the ligamentum arteriosum before heading up to the larynx. In addition to the more-frequent causes of compromise, such as tumors or surgery, the nerve is also susceptible to compression by any structure in the vicinity of the aortopulmonary window. Norbert Ortner (1865-1935) described vocal cord paralysis in the setting of a dilated left atrium. The nerve is compressed between the pulmonary artery and the aorta, generally in the setting of mitral valve disease. The CT scan in this patient reveals the dilated left atrium (10 cm), which is the presumed cause of her vocal cord paralysis.
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Author:
John Ronald, MD, FRCPC
University of Manitoba
Associate Editor:
Sean Tsuyuki, MD
St Boniface General Hospital
eMedicine Editor:
Sat Sharma, MD
University of Manitoba
Source
http://emedicine.com
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