Ortner's syndrome presenting as thoracic aortic aneurysm mimicking thoracic malignancy: a case report

Ortner's syndrome is defined as left recurrent laryngeal nerve palsy caused by a cardiovascular pathology. Here we report the case of a 68-year-old man who presented to our hospital with hoarseness, whose initial chest imaging mimicked a thoracic neoplastic process with left pleural effusion. T...

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Bibliographic Details
Published in:Journal of medical case reports 2015-06, Vol.9 (1), p.147-147, Article 147
Main Authors: Pathirana, Upul, Kularatne, Saman, Handagala, Sumana, Ranasinghe, Gamini, Samarasinghe, Ravinda
Format: Article
Language:English
Subjects:
Aged
Aneurysm, Ruptured - complications
Aneurysm, Ruptured - diagnosis
Aneurysm, Ruptured - diagnostic imaging
Aortic Aneurysm, Thoracic - complications
Aortic Aneurysm, Thoracic - diagnosis
Aortic Aneurysm, Thoracic - diagnostic imaging
Aortic aneurysms
Cancer
Care and treatment
Case Report
Case studies
CT imaging
Development and progression
Diagnosis
Diagnosis, Differential
Hoarseness - etiology
Humans
Hypertension
Male
Smoking
Syndrome
Tomography, X-Ray Computed
Vocal Cord Paralysis - complications
Vocal Cord Paralysis - diagnosis
Vocal Cord Paralysis - diagnostic imaging
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Summary:Ortner's syndrome is defined as left recurrent laryngeal nerve palsy caused by a cardiovascular pathology. Here we report the case of a 68-year-old man who presented to our hospital with hoarseness, whose initial chest imaging mimicked a thoracic neoplastic process with left pleural effusion. The final diagnosis was Ortner's syndrome due to the silent rupture of a thoracoabdominal aortic aneurysm. Diagnostic thoracentesis, before computed tomography, in resource-poor settings, may have resulted in an adverse outcome in our case. A 68-year-old Sri Lankan man was referred to us by an otolaryngologist for further evaluation of a suspected thoracic malignancy. His presenting symptom was hoarseness of three months duration. He had essential hypertension for the last four years and had a history of 25 pack-years of cigarettes smoking. His chest X-ray showed a left-sided mediastinal mass with mild to moderate pleural effusion. An ultrasound appeared to show an encysted pleural fluid collection. However, we proceeded with computed tomography before diagnostic thoracentesis. The diagnosis of Ortner's syndrome was made after the computed tomography due to the silent rupture of his thoracoabdominal aortic aneurysm. Hoarseness due to left recurrent laryngeal nerve palsy can be the presenting symptom of cardiovascular pathologies, Ortner's syndrome. Silent rupture of thoracic aortic aneurysms can mimic that of thoracic malignancy, which is reported in literature. We illustrate the importance of a high degree of suspicion of cardiovascular pathology in order to avoid an adverse outcome following diagnostic thoracentesis.
ISSN:1752-1947
1752-1947
DOI:10.1186/s13256-015-0629-1