Ortner’s syndrome associated with a saccular aortic arch aneurysm presenting as isolated unilateral vocal cord paralysis: a case report
Alisha Surkheti, Nishant Pandey, Bibek Ghimire, Sagun Sapkota, Bijaya Poudel, Bishal BanmalaBackground:
Ortner’s syndrome, or cardiovocal syndrome, is an uncommon cause of recurrent laryngeal nerve palsy due to cardiovascular pathology. Thoracic aortic aneurysm is a rare but important etiology that may present only with hoarseness.
Case presentation:
An 85-year-old man with hypertension and a history of chronic smoking presented with progressive hoarseness for 1 month. Flexible laryngoscopy showed paralysis of the left vocal cord without laryngeal pathology. Contrast-enhanced computed tomography (CT) revealed a 22 × 17 mm saccular aneurysm arising from the distal aortic arch at the aortopulmonary window, with mural thrombus and in close proximity to the left recurrent laryngeal nerve. No cervical, mediastinal, pulmonary, or laryngeal malignancy was detected. Echocardiography showed preserved systolic function without significant valvular disease or pulmonary hypertension. Ortner’s syndrome associated with the distal aortic arch aneurysm was considered the most likely diagnosis based on the clinical and radiological findings and the exclusion of other identifiable causes. Surgical repair was advised, but the patient declined and was managed conservatively. At the 11-month clinical follow-up, he remained stable with persistent hoarseness; no follow-up CT was performed.
Clinical discussion:
Aortic arch aneurysm is a rare cause of Ortner’s syndrome and may mimic more common causes of unilateral vocal cord paralysis, particularly malignancy. Imaging along the recurrent laryngeal nerve pathway, including the thorax, is essential when laryngoscopy does not reveal a local cause.
Conclusion:
Unexplained left vocal cord paralysis should prompt an evaluation for cardiovascular causes. Early cross-sectional imaging can identify a thoracic aortic aneurysm and guide timely multidisciplinary management.