The Silent Aneurysm Behind the Hoarse Voice: Ortner's Syndrome

Unilateral recurrent laryngeal nerve palsy presenting with hoarseness of voice is a common clinical condition with multiple etiological factors, most commonly malignancy, iatrogenic injury, and neurological disorders. Cardiovascular causes are relatively uncommon and are described under Ortner's syndrome, also known as cardiovocal syndrome. Here, we describe the case of a 76-year-old gentleman who presented with progressively worsening hoarseness of voice and aspiration of fluids for two months. Video laryngoscopy revealed left vocal cord palsy and a phonatory gap. Contrast-enhanced computed tomography of the neck and chest demonstrated a saccular aneurysm of the distal aortic arch with mural thrombus compressing the course of the left recurrent laryngeal nerve. A diagnosis of Ortner's syndrome secondary to a saccular aortic arch aneurysm was made. This case highlights the need to consider Ortner's syndrome as a possible diagnosis in patients presenting with new-onset hoarseness of voice, particularly those with underlying cardiovascular disease.