Arifputera Andy, Loo Germaine, Chang Peter, Kojodjojo Pipin
Singapore Med J. 2014 Feb;55(2):e31-3. doi: 10.11622/smedj.2013212.
A 68-year-old man presented with a six-month history of painless dysphagia, malnutrition, anorexia and vocal hoarseness. Signs of severe mitral regurgitation and preserved left atrial dimensions were discovered on transthoracic echocardiography. However, electrocardiography and chest radiography were strongly suggestive of left atrial enlargement. Further investigations confirmed extrinsic compression of the oesophagus, which caused the dysphagia. Computed tomography of the throrax revealed a giant left atrium that was not appreciated on echocardiography. Hoarseness was found to be caused by right recurrent laryngeal nerve palsy. Ortner’s syndrome, which describes the occurrence of vocal hoarseness due to a cardiopulmonary disease that results in the compression of the left recurrent laryngeal nerve, is usually associated with severe mitral stenosis. Herein, we report an unusual case of Ortner’s syndrome caused by a giant left atrium, which resulted from severe mitral regurgitation, causing extrinsic oesophageal compression and right recurrent laryngeal nerve palsy. Physicians should remain cognisant of cardiovascular disorders as uncommon causes of painless dysphagia or vocal hoarseness.
一名68岁男性，有6个月无痛性吞咽困难、营养不良、厌食和声音嘶哑病史。经胸超声心动图发现严重二尖瓣反流且左心房大小正常的体征。然而，心电图和胸部X线检查强烈提示左心房扩大。进一步检查证实食管受外部压迫，导致吞咽困难。胸部计算机断层扫描显示巨大左心房，这在超声心动图中未被发现。发现声音嘶哑是由右侧喉返神经麻痹引起的。奥尔特纳综合征描述了由于心肺疾病导致左喉返神经受压而出现声音嘶哑，通常与严重二尖瓣狭窄有关。在此，我们报告一例由巨大左心房引起的奥尔特纳综合征罕见病例，该巨大左心房由严重二尖瓣反流导致，引起食管外部压迫和右侧喉返神经麻痹。医生应认识到心血管疾病是无痛性吞咽困难或声音嘶哑的罕见原因。
