Department of Otorhinolaryngology, Chi Mei Medical Center, Tainan, Taiwan.
Department of Pet Care and Grooming, Chung Hwa University of Medical Technology, Tainan, Taiwan.
Medicine (Baltimore). 2022 Dec 9;101(49):e32272. doi: 10.1097/MD.0000000000032272.
Ortner syndrome (cardiovocal hoarseness) is characterized by recurrent laryngeal nerve paralysis secondary to a cardiovascular abnormality. Ortner syndrome caused by an aberrant right subclavian artery following a retroesophageal course without aneurysm formation is rare, with only 1 case reported in the literature. Cardiovascular abnormalities could be life-threatening and require early diagnosis and treatment. However, such abnormalities are not often considered by clinical practitioners when patients initially present with hoarseness.
A 34-year-old woman without any medical history presented to our outpatient department with hoarseness and mild dysphagia for 1 month.
Upon stroboscopic examination, left vocal cord incomplete paralysis was noted. Contrast-enhanced computed tomography revealed an aberrant right subclavian artery arising from the left aortic arch, causing focal compression of the esophagus and, potentially, compression of the left recurrent laryngeal nerve compression. The patient was diagnosed as left recurrent laryngeal nerve paralysis caused by an aberrant right subclavian artery following a retroesophageal course without aneurysm formation.
The patient was referred to a cardiovascular surgeon for resection and bypass surgery. Both the dysphagia and the hoarseness improved after the surgery.
Significant improvement of the left vocal cord paralysis and no vocal cord adduction were seen upon stroboscopic examination after 3 months. During the 5-year follow-up period, the patient remained well, and no signs of recurrence were noted.
This case can increase otolaryngologists' awareness of this etiology of hoarseness and consider it in their differential diagnosis.
Ortner 综合征（心音性声嘶）的特征为心血管异常导致的反复性喉返神经麻痹。由走行于食管后方且未形成动脉瘤的异常右锁骨下动脉引起的 Ortner 综合征较为罕见，文献中仅报告过 1 例。心血管异常可能危及生命，需要早期诊断和治疗。然而，当患者最初出现声嘶时，临床医生通常不会考虑到这些异常。
一位 34 岁的女性，无任何既往病史，因声嘶和轻度吞咽困难 1 个月就诊于我院门诊。
频闪喉镜检查示左侧声带不完全麻痹。增强 CT 显示异常的右锁骨下动脉起自左主动脉弓，导致食管局部受压，并可能压迫左侧喉返神经。患者被诊断为左喉返神经麻痹，由走行于食管后方且未形成动脉瘤的异常右锁骨下动脉引起。
患者转至心血管外科医生处行切除术和旁路手术。手术后吞咽困难和声音嘶哑均改善。
3 个月后频闪喉镜检查示左侧声带麻痹显著改善，声带无内收。随访 5 年期间，患者状况良好，未见复发迹象。
该病例可提高耳鼻喉科医生对这种声嘶病因的认识，并将其纳入鉴别诊断中。
