Ortner’s syndrome or cardiovocal hoarseness
Ortner’s syndrome or cardiovocal hoarseness
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奥特纳综合征或心声嘶哑
DOI：
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发表时间：
2007
期刊：
影响因子：
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通讯作者：
R. Strasser
中科院分区：
文献类型：
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作者：
C. Wunderlich;O. Wunderlich;A. Tausche;J. Fuhrmann;A. Boscheri;R. Strasser
一名66岁的白人男子自发的声音嘶哑，促使他去咨询门诊耳鼻喉科专家。由于左声带明显麻痹，患者在非教学医院住院，并获得了所描述的胸片（图1）。在怀疑主动脉夹层的情况下，病人被转到我们的重症监护室。立即增强计算机断层扫描（CT）显示主动脉弓假动脉瘤，其入口位于左锁骨下动脉远端（图2A）。值得注意的是，病人不记得创伤性事件。在侵入性地排除了严重的冠状动脉疾病后，病变用覆盖假动脉瘤的动脉壁支架进行了平稳的治疗。介入后CT图像显示假腔完全血栓形成（图2b）。在六个月的随访中，他的声音嘶哑也消失了。迄今为止，只有少数这样的案例被描述过。早在1897年，Ortner就首次描述了由于二尖瓣狭窄导致左房增大的患者声音嘶哑。随后，这一临床实体被报道为各种心血管异常的罕见并发症，如房间隔缺损、肺动脉高压和累及主动脉弓的主动脉瘤。在这种综合征中，左喉返神经被认为是由于心脏或大血管的解剖变化引起的压迫或牵引而受伤。虽然肿瘤和手术治疗是喉返神经麻痹的主要原因，但心血管病变也可以出现。图1胸片显示主动脉弓可疑隆起，指导后续诊断步骤。
A spontaneously occurring hoarseness prompted a 66-year-old Caucasian man to consult an outpatient ear, nose and throat specialist. As the result of a conspicuous paralysis of his left vocal cord the patient was hospitalized in a non-teaching hospital where the depicted chest radiograph was obtained (Fig. 1). Under suspicion of an aortic dissection the patient was referred to our intensive care unit. An immediate contrast-enhanced computed tomography (CT) scan indicated a false aneurysm of the aortic arch with the entry distal the left subclavian artery (Fig. 2A). Notably the patient did not remember a traumatic event. After having invasively ruled out a significant coronary artery disease the lesion wasuneventfully treatedwith anaorticwall stent covering the false aneurysm. A post-interventional CT image showed a complete thrombosis of the false lumen (Fig. 2 B). In the 6-month follow up his hoarseness also disappeared. To date only a few such cases have been described. As early as 1897 Ortner first described hoarseness in patients with left atrial enlargement due to mitral valve stenosis. Subsequently, this clinical entity was reported as a rare complication of various cardiovascular abnormalities, such as atrial septal defects, pulmonary hypertension and aortic aneurysms involving the aortic arch. In this syndrome the left recurrent laryngeal nerve is believed to be injured because of compression or traction caused by changes in the anatomy of the heart or great vessels. Although neoplasms and surgical interventions account for most of the recurrent laryngeal nerve palsies, cardiovascular pathologies can also Figure 1 Chest radiograph indicating a suspicious bulge of the aortic arch, which guided subsequent diagnostic steps.