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

Pathirana U, Kularatne S, Handagala S, Ranasinghe G, Samarasinghe R - J Med Case Rep (2015)

Bottom Line: Diagnostic thoracentesis, before computed tomography, in resource-poor settings, may have resulted in an adverse outcome in our case.However, we proceeded with computed tomography before diagnostic thoracentesis.We illustrate the importance of a high degree of suspicion of cardiovascular pathology in order to avoid an adverse outcome following diagnostic thoracentesis.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, National Hospital for Respiratory Diseases, Negombo Road, Welisara, Sri Lanka. mailtoupul@gmail.com.

ABSTRACT

Introduction: 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.

Case presentation: 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.

Conclusions: 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.

No MeSH data available.


Related in: MedlinePlus

Volume-rendered image showing fusiform dilatation of the aorta (white arrow) from the aortic root to the bifurcation
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Fig3: Volume-rendered image showing fusiform dilatation of the aorta (white arrow) from the aortic root to the bifurcation

Mentions: His contrast-enhanced computed tomography (CT) scan with aortography showed a thoracoabdominal aortic aneurysm with peripheral thrombosis (Fig. 2). The left-sided pleural effusion was suggestive of a leaking aneurysm. A volume-rendered image of his aorta showed fusiform dilatation of the entire aorta, from aortic root to the bifurcation (Fig. 3).Fig. 2


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

Pathirana U, Kularatne S, Handagala S, Ranasinghe G, Samarasinghe R - J Med Case Rep (2015)

Volume-rendered image showing fusiform dilatation of the aorta (white arrow) from the aortic root to the bifurcation
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4481080&req=5

Fig3: Volume-rendered image showing fusiform dilatation of the aorta (white arrow) from the aortic root to the bifurcation
Mentions: His contrast-enhanced computed tomography (CT) scan with aortography showed a thoracoabdominal aortic aneurysm with peripheral thrombosis (Fig. 2). The left-sided pleural effusion was suggestive of a leaking aneurysm. A volume-rendered image of his aorta showed fusiform dilatation of the entire aorta, from aortic root to the bifurcation (Fig. 3).Fig. 2

Bottom Line: Diagnostic thoracentesis, before computed tomography, in resource-poor settings, may have resulted in an adverse outcome in our case.However, we proceeded with computed tomography before diagnostic thoracentesis.We illustrate the importance of a high degree of suspicion of cardiovascular pathology in order to avoid an adverse outcome following diagnostic thoracentesis.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, National Hospital for Respiratory Diseases, Negombo Road, Welisara, Sri Lanka. mailtoupul@gmail.com.

ABSTRACT

Introduction: 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.

Case presentation: 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.

Conclusions: 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.

No MeSH data available.


Related in: MedlinePlus