Ortner’s Syndrome: A Case Report of Left Recurrent Laryngeal Nerve Palsy Secondary to Aortic Aneurysm

Introduction Ortner’s syndrome, or cardiovocal syndrome, is a rare condition caused by compression and palsy of the recurrent laryngeal nerve (RLN). Common symptoms are hoarseness and dyspnea, typically secondary to cardiovascular abnormalities. Diagnosis can be challenging, due to the rarity of RLN compression from cardiovascular pathology and the required anatomical knowledge. Case Presentation We report a case of a 73-year old male with a past medical history of hypertension, dyslipidaemia, and chronic kidney disease, who presented in an outpatient clinic with progressive hoarseness and dyspnea. Initial investigations excluded the differential diagnosis of a pulmonary embolism, and a computed tomography (CT) scan revealed an aortic aneurysm, measuring 8,7 cm in diameter, compressing the left RLN. Consequently, laryngoscopy confirmed vocal cord dysfunction and a diagnosis of Ortner’s syndrome was made. A multidisciplinary team recommended antihypertensive therapy to stabilise the patient's condition while awaiting aortic replacement surgery, which is planned within the next months. Discussion The medical history of patients diagnosed with Ortner's syndrome includes pulmonary hypertension in 35%, mitral stenosis in 17%, and general hypertension in 12% of cases. The most common cause of this condition is aortic aneurysms [1]. The left RLN is more often compressed compared to the right RLN due to its anatomical position, looping around the thoracic aortic arch. Both nerves innervate the vocal cords. In addition to hoarseness, other symptoms in patients with Ortner's syndrome include dyspnea, dysphagia, and cough [1,2]. CT and CT angiography are important tools for detecting aneurysms, while laryngoscopy is used to confirm vocal cord dysfunction [1]. In cases where an aneurysm is identified as the cause of Ortner’s syndrome, surgical options such as open aortic repair or thoracic endovascular aortic repair (TEVAR) are the most common treatments, improving hoarseness in 85% of cases [1,3]. Conclusions This case presents a rare occurrence of hoarseness due to an aortic aneurysm compressing the left RLN. CT angiography was vital for diagnosis, and a multidisciplinary approach, including antihypertensive treatment and surgery, can reduce complications, making this syndrome potentially reversible.