Case Presentation:
A 38-year-old woman with a history of bilharziasis presented with progressive dyspnea over the past 5 years and a 1-year-history of horsiness of voice. Chest X-ray showed enlarged cardiac shadow with a dilated pulmonary trunk (Figure 1, Panel A). Echocardiography revealed dilated pulmonary artery and branches and moderate pulmonary regurgitation (Figure 1, Panel B, C) (Video 1,2). Computed Tomography (CT) of Chest and Pulmonary Angiography showed dilatation of the main pulmonary and both pulmonary artery branches. (Figure 1, Panel D, E). Laryngoscopic examination revealed left vocal cord paralysis with immobile vocal cord in paramedian position. She was counselled about surgical decompression but refused surgery. Ortner’s syndrome is due to left recurrent laryngeal nerve compression, commonly caused by left atrial enlargement due to mitral stenosis, other rare cardiac causes include thoracic aortic aneurysm, aberrant subclavian artery and pulmonary artery aneurysm. Echocardiography may not satisfactory for a definitive diagnosis. CT is crucial for differential diagnosis of compression causes. Nerve decompression may reverse hoarseness if the duration is not long and the nerve is not permanently damaged. However, ischemic nerve injuries are usually irreversible.