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.