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A6762 - A Case of Ortner Syndrome
Author Block: J. Singh1, G. Chaviano1, A. T. Scardella2; 1Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States, 2Rutgers Robert Wood Johnson Med Sch, New Brunswick, NJ, United States.
ABSTRACT Intro: Hoarseness is a common clinical symptom with a wide differential.1 A rare cause is Ortner’s syndrome, a condition characterized by left recurrent laryngeal nerve palsy secondary to underlying cardiovascular disease, including pulmonary hypertension.3 Atrial septal defect (ASD) is a commonly recognized congenital anomaly known to cause pulmonary hypertension over time, with sinus venosus being the least common type of ASD.4 Case: 33 year old female two weeks post-partum presented with worsening dyspnea and pulmonary edema on CXR. The patient has a past medical history significant for cardiomegaly of unknown etiology, hypothyroidism, and dysphonia secondary to vocal cord paralysis. Echocardiogram showed severe pulmonary hypertension and enlarged pulmonary arteries, with preserved left ventricular function and a positive bubble study. A follow up transesophageal echocardiogram (TEE) confirmed the presence of a sinus venosus, the likely etiology of her pulmonary hypertension. Subsequent right heart catheterization showed mean pulmonary artery pressure of fourty six mmHg. At this time, patient was diagnosed with Ortner’s syndrome due to the enlarged pulmonary artery compressing the recurrent laryngeal nerve. Discussion: Ortner’s Syndrome is a rare sequalae of pulmonary hypertension that, in this case, went undiagnosed. Patients with this syndrome have underlying cardiac diseases such as mitral stenosis, aortic aneurysms, and septal defects.2 In sinus venosus, the defect occurs where the pulmonary veins enter the heart at the junction of the right atrium and superior vena cava. Thus, one or more of the pulmonary veins enter the right atrium instead of the left. 4 This type of ASD is often missed on transthoracic echocardiogram, and patients can be misdiagnosed with primary pulmonary hypertension.4 We want to highlight the utility of further evaluation with TEE if there is suspicion of ASD. In our case, recognition of Ortner’s syndrome two years earlier would have initiated pulmonary hypertension work up and started on appropriate treatment or even surgery.REFERENCES: 1. Yuan, Shi-Min. “Hoarseness subsequent to cardiovascular surgery, intervention, maneuver and endotracheal intubation: The so-Called iatrogenic Ortner’s syndrome.” Cardiology Journal, vol. 19, no. 6, June 2012, pp. 560-566 2. Bickle, I. C., B. E. Kelly, and D. S. Brooker. “Ortner’s Syndrome: A Radiological Diagnosis.” The Ulster Medical Journal 71.1 (2002): 55-56. 3. Shahul, HA, et al. “Ortner’s Syndrome.” BMJ Case Rep 2016, pp. 2014.,4. Sharma, Awadhesh Kr, et al. “A case of sinus venosus atrial septal defect misdiagnosed as primary pulmonary hypertension.” Hellenic Journal of Cardiology, vol. 57, no. 2, 2016, pp. 124-128.,