Ortner’s syndrome due to aneurysmal dilatation of the left pulmonary artery secondary to mixed pulmonary valve disease

A young female patient was referred by her general practitioner to the ear, nose and throat outpatient clinic with a 5-year history of progressive hoarseness and loss of voice. A chest radiograph was reported as showing marked dilatation of the left pulmonary artery without any other features to suggest underlying pulmonary arterial hypertension. A provisional diagnosis of left recurrent laryngeal nerve palsy secondary to its compression between the left pulmonary artery and the undersurface of the aortic arch—Ortner’s or cardiovocal syndrome—was suggested and confirmed on further investigation including CT, microlaryngoscopy and echocardiography.