Losing the Voice to the Lungs: Ortner’s Syndrome in Pulmonary Vascular Disease

Abstract

Ortner’s syndrome, also known as cardiovocal syndrome, is a rare clinical condition marked by left recurrent laryngeal nerve palsy. It is most commonly caused by mechanical compression or traction of the nerve between the aortic arch and the pulmonary artery, typically triggered by underlying cardiovascular diseases like aortic aneurysms or mitral stenosis. In 1897, Norbert Ortner elucidated the association between left recurrent laryngeal nerve palsy and severe mitral valve stenosis, which leads to hoarseness of voice. Although it was originally described in association with severe mitral stenosis, the syndrome may arise from several other causes. These include compression of the nerve by vascular conditions such as aortic aneurysm, aortic dissection, and pulmonary hypertension. We present a case of Ortner’s syndrome in a 41-year-old man, characterized by dysphonia from left recurrent laryngeal nerve compression, secondary to severe pulmonary arterial hypertension and embolic pulmonary occlusion. This case emphasizes the need to carefully consider cardiac causes in patients with vocal cord dysfunction and supports the use of a comprehensive, team-based approach to diagnosis and treatment.