Ortner's syndrome: Difference between revisions

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'''Ortner's syndrome''' is a rare cardiovocal [[syndrome]] and refers to [[recurrent laryngeal nerve]] [[:wikt:palsy|palsy]] from [[cardiovascular]] [[disease]].<ref>{{cite journal |vauthors=Bickle IC, Kelly BE, Brooker DS |title=Ortner's syndrome: a radiological diagnosis |journal=Ulster Med J |volume=71 |issue=1 |pages=55–6 |date=May 2002 |pmid=12137166 |pmc=2475354 }}</ref> It was first described by [[Norbert Ortner]] (1865&ndash;1935), an [[Austria]]n physician, in 1897.
'''Ortner's syndrome''' is a rare cardiovocal [[syndrome]] and refers to [[recurrent laryngeal nerve]] [[:wikt:palsy|palsy]] from [[cardiovascular]] [[disease]].<ref>{{cite journal |last1=Bickle |first1=IC |last2=Kelly |first2=BE |last3=Brooker |first3=DS |title=Ortner's syndrome: a radiological diagnosis. |journal=The Ulster medical journal |date=May 2002 |volume=71 |issue=1 |pages=55-6 |pmid=12137166 |display-authors=2}}</ref> It was first described by [[Norbert Ortner]] (1865&ndash;1935), an [[Austria|Austrian]] physician, in 1897.


[[Dysphagia]] caused by a similar mechanism is referred to as '''dysphagia aortica''', or, in the case of [[subclavian artery]] aberrancy, as [[dysphagia lusoria]].
[[Dysphagia]] caused by a similar mechanism is referred to as '''dysphagia aortica''', or, in the case of [[subclavian artery]] aberrancy, as [[dysphagia lusoria]].
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== Differential Diagnosis ==
== Differential Diagnosis ==
Due to its low frequency of occurrence, other, more common, causes of [[hoarseness]] should be considered when suspecting [[vocal cord paresis|left recurrent laryngeal nerve palsy]].
Due to its low frequency of occurrence, more common causes of [[hoarseness]] should be considered when suspecting [[vocal cord paresis|left recurrent laryngeal nerve palsy]]. These include:
* [[Surgical]] intervention ([[thyroidectomy]], [[parathyroidectomy]])
* [[Surgical]] intervention ([[thyroidectomy]], [[parathyroidectomy]])
* [[Endotracheal intubation]]
* [[Endotracheal intubation]]
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* [[Trauma]]
* [[Trauma]]
* [[Stroke]] ([[bulbar palsy]], [[demyelinating disease]])
* [[Stroke]] ([[bulbar palsy]], [[demyelinating disease]])
* [[Idiopathic]] <ref>Culp JM, Patel G. Recurrent Laryngeal Nerve Injury. 2020 Jul 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 32809667.</ref>
* [[Idiopathic]]<ref>Culp JM, Patel G. Recurrent Laryngeal Nerve Injury. 2020 Jul 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 32809667.</ref>


== Pathophysiology ==
== Pathophysiology ==
The most common historical cause is a dilated [[left atrium]] due to [[mitral stenosis]], but other causes, including [[pulmonary hypertension]],<ref>{{cite journal |vauthors=Hermans C, Manocha S, McLaughlin JE, Lipman M, Lee CA |title=Ortner syndrome and haemophilia |journal=Haemophilia |volume=11 |issue=5 |pages=548–51 |date=September 2005 |pmid=16128901 |doi=10.1111/j.1365-2516.2005.01140.x }}</ref> thoracic [[aorta|aortic]] [[aneurysms]], an enlarged [[pulmonary artery]]<ref>{{cite web|last1=Armstrong|first1=Guy|title=Mitral Stenosis|url=http://www.merckmanuals.com/professional/cardiovascular-disorders/valvular-disorders/mitral-stenosis|website=Merck Manual|publisher=Merck Manual|accessdate=2015-04-19}}</ref> and [[aberrant subclavian artery]] syndrome have been reported compressing the nerve.<ref>{{cite journal |vauthors=Escribano JF, Carnés J, Crespo MA, Antón RF |title=Ortner's syndrome and endoluminal treatment of a thoracic aortic aneurysm: a case report |journal=Vasc Endovascular Surg |volume=40 |issue=1 |pages=75–8 |year=2006 |pmid=16456610 |doi=10.1177/153857440604000111}}</ref>
The most common historical cause is a dilated [[left atrium]] due to [[mitral stenosis]], but other causes, including [[pulmonary hypertension]],<ref>{{cite journal |vauthors=Hermans C, Manocha S, McLaughlin JE, Lipman M, Lee CA |title=Ortner syndrome and haemophilia |journal=Haemophilia |volume=11 |issue=5 |pages=548–51 |date=September 2005 |pmid=16128901 |doi=10.1111/j.1365-2516.2005.01140.x |s2cid=37404100 }}</ref> thoracic [[aorta|aortic]] [[aneurysms]], an enlarged [[pulmonary artery]]<ref>{{cite web|last1=Armstrong|first1=Guy|title=Mitral Stenosis|url=http://www.merckmanuals.com/professional/cardiovascular-disorders/valvular-disorders/mitral-stenosis|website=Merck Manual|publisher=Merck Manual|accessdate=2015-04-19}}</ref> and [[aberrant subclavian artery]] syndrome have been reported compressing the nerve.<ref>{{cite journal |last1=Escribano |first1=Josè F. Guijarro |last2=Carnès |first2=Jerûnimo |last3=Crespo |first3=Miguel A. Brinquis |last4=Antûn |first4=Rafael Fern·ndez |title=Ortner's Syndrome and Endoluminal Treatment of a Thoracic Aortic Aneurysm: A Case Report |journal=Vascular and Endovascular Surgery |date=January 2006 |volume=40 |issue=1 |pages=75–78 |doi=10.1177/153857440604000111 |display-authors=2}}</ref>


A few notable cases are discussed below:
A few notable cases are discussed below:
* [[Pseudoaneurysm]]: A male with long-standing uncontrolled [[hypertension]] and hoarseness of voice attributed to life-long smoking was found to have a [[pseudoaneurysm]] of the [[aortic arch]] which was compressing the LRLN. <ref>Al Kindi AH, Al Kindi FA, Al Abri QS, Al Kemyani NA. Ortner's syndrome: Cardiovocal syndrome caused by aortic arch pseudoaneurysm. J Saudi Heart Assoc. 2016;28(4):266-269. doi:10.1016/j.jsha.2016.02.006</ref>
* [[Pseudoaneurysm]]: A male with long-standing uncontrolled [[hypertension]] and hoarseness of voice attributed to life-long smoking was found to have a [[pseudoaneurysm]] of the [[aortic arch]] which was compressing the LRLN.<ref>{{cite journal |last1=Al Kindi |first1=Adil H. |last2=Al Kindi |first2=Faiza A. |last3=Al Abri |first3=Qasim S. |last4=Al Kemyani |first4=Nasser A. |title=Ortner's syndrome: Cardiovocal syndrome caused by aortic arch pseudoaneurysm |journal=Journal of the Saudi Heart Association |date=October 2016 |volume=28 |issue=4 |pages=266–269 |doi=10.1016/j.jsha.2016.02.006 |pmid=27688676 |pmc=5034482 |display-authors=2}}</ref>
* [[Valvular heart disease]]: A middle-aged male had ongoing [[cough]], hoarseness of voice, and [[shortness of breath]] for two years without a history of smoking was found to have [[mitral valve stenosis]] due to [[valvular heart disease|calcification]]. This led to [[left atrial enlargement]], elevated [[pulmonary hypertension|pulmonary artery pressure]], [[pulmonary hypertension|pulmonary artery hypertension]], and [[ventricular enlargement|right ventricular enlargement]]. This [[cardiomegaly]], or enlargement of the heart, led to compression of the LRLN.<ref>Subramaniam V, Herle A, Mohammed N, Thahir M. Ortner's syndrome: case series and literature review. Braz J Otorhinolaryngol. 2011 Sep-Oct;77(5):559-62. English, Portuguese. doi: 10.1590/s1808-86942011000500004. PMID: 22030961.</ref>
* [[Valvular heart disease]]: A middle-aged male had ongoing [[cough]], hoarseness of voice, and [[shortness of breath]] for two years without a history of smoking was found to have [[mitral valve stenosis]] due to [[valvular heart disease|calcification]]. This led to [[left atrial enlargement]], elevated [[pulmonary hypertension|pulmonary artery pressure]], [[pulmonary hypertension|pulmonary artery hypertension]], and [[ventricular enlargement|right ventricular enlargement]]. This [[cardiomegaly]], or enlargement of the heart, led to compression of the LRLN.<ref>{{cite journal |last1=Subramaniam |first1=Vijayalakshmi |last2=Herle TV |first2=Adarsha |last3=Mohammed |first3=Navisha |last4=Thahir |first4=Muhammad |title=Ortner's syndrome: case series and literature review |journal=Brazilian Journal of Otorhinolaryngology |date=October 2011 |volume=77 |issue=5 |pages=559–562 |doi=10.1590/s1808-86942011000500004 |pmid=22030961 |display-authors=2}}</ref>
* [[Mixed connective tissue disease]]: A young female with a history of [[mixed connective tissue disease]] presented with hoarseness of voice and was found to have secondary [[pulmonary hypertension|pulmonary artery hypertension]]. This was causing right heart enlargement and therefore compression of the LRLN.
* [[Mixed connective tissue disease]]: A young female with a history of [[mixed connective tissue disease]] presented with hoarseness of voice and was found to have secondary [[pulmonary hypertension|pulmonary artery hypertension]]. This was causing right heart enlargement and therefore compression of the LRLN.


Revision as of 08:54, 10 November 2020

Ortner's syndrome
Image of aortic anatomy showing proximity of vagus nerve and its recurrent branch to the aorta
SpecialtyNeurology

Ortner's syndrome is a rare cardiovocal syndrome and refers to recurrent laryngeal nerve palsy from cardiovascular disease.[1] It was first described by Norbert Ortner (1865–1935), an Austrian physician, in 1897.

Dysphagia caused by a similar mechanism is referred to as dysphagia aortica, or, in the case of subclavian artery aberrancy, as dysphagia lusoria. Due to compression of recurrent laryngeal nerve it can cause the hoarseness of the voice, which can also be a sign of mitral stenosis. A second Ortner's syndrome, Ortner's syndrome II, refers to abdominal angina.

History

This correlation between hoarseness of voice and cardiac anatomic pathology was first described by Dr. Norbert Ortner in 1987 after he observed left recurrent laryngeal nerve palsy (LRLN) in three patients with left atrial enlargement secondary to mitral valve stenosis.[2] The definition of Ortner’s syndrome has since then expanded to encompass all possible causes of left recurrent laryngeal nerve palsy with cardiac etiologies.

Differential Diagnosis

Due to its low frequency of occurrence, more common causes of hoarseness should be considered when suspecting left recurrent laryngeal nerve palsy. These include:

Pathophysiology

The most common historical cause is a dilated left atrium due to mitral stenosis, but other causes, including pulmonary hypertension,[4] thoracic aortic aneurysms, an enlarged pulmonary artery[5] and aberrant subclavian artery syndrome have been reported compressing the nerve.[6]

A few notable cases are discussed below:

References

  1. ^ Bickle, IC; Kelly, BE; et al. (May 2002). "Ortner's syndrome: a radiological diagnosis". The Ulster medical journal. 71 (1): 55–6. PMID 12137166.
  2. ^ Ortner N. Recurrent nerve palsy in patient with mitral stenosis. Wien Klin Wochenschr. 1897;10:753–755. [in German]).
  3. ^ Culp JM, Patel G. Recurrent Laryngeal Nerve Injury. 2020 Jul 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 32809667.
  4. ^ Hermans C, Manocha S, McLaughlin JE, Lipman M, Lee CA (September 2005). "Ortner syndrome and haemophilia". Haemophilia. 11 (5): 548–51. doi:10.1111/j.1365-2516.2005.01140.x. PMID 16128901. S2CID 37404100.
  5. ^ Armstrong, Guy. "Mitral Stenosis". Merck Manual. Merck Manual. Retrieved 2015-04-19.
  6. ^ Escribano, Josè F. Guijarro; Carnès, Jerûnimo; et al. (January 2006). "Ortner's Syndrome and Endoluminal Treatment of a Thoracic Aortic Aneurysm: A Case Report". Vascular and Endovascular Surgery. 40 (1): 75–78. doi:10.1177/153857440604000111.
  7. ^ Al Kindi, Adil H.; Al Kindi, Faiza A.; et al. (October 2016). "Ortner's syndrome: Cardiovocal syndrome caused by aortic arch pseudoaneurysm". Journal of the Saudi Heart Association. 28 (4): 266–269. doi:10.1016/j.jsha.2016.02.006. PMC 5034482. PMID 27688676.
  8. ^ Subramaniam, Vijayalakshmi; Herle TV, Adarsha; et al. (October 2011). "Ortner's syndrome: case series and literature review". Brazilian Journal of Otorhinolaryngology. 77 (5): 559–562. doi:10.1590/s1808-86942011000500004. PMID 22030961.


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