PDF(Pubmed)
Abstract：
BACKGROUND Ortner syndrome, or cardiovocal syndrome, is a left recurrent laryngeal nerve palsy secondary to cardiovascular causes. Aortic pseudoaneurysm is a rare life-threatening condition resulting from weakening of the aortic wall. Clinical presentation of aortic pseudoaneurysm is highly variable. Hoarseness is often caused by benign conditions; however, it can be the first symptom of an underlying serious condition requiring immediate diagnosis and management. CASE REPORT We report a series of 2 patients with sudden hoarseness as the first symptom of an aortic arch pseudoaneurysm. Two men, with ages of 76 and 60 years, had sudden hoarseness a few weeks before. Laryngoscopy showed a left vocal cord palsy in both cases. A computed tomography (CT) scan showed a thoracic aortic pseudoaneurysm located at the aortic arch compressing the left recurrent laryngeal nerve. Both patients were treated with endovascular aortic repair. The first patient underwent a carotid-subclavian artery bypass, and the left subclavian artery was closed with a vascular plug device. He was discharged a week later, with persistent hoarseness. In the second case, subclavian artery occlusion and pseudoaneurysm embolization with coils were performed. Control CT scan confirmed the procedure\'s success. However, after an initial favorable evolution, the patient had severe non-vascular complications and finally died. CONCLUSIONS Considering these 2 cases and those reported in the literature, aortic origin should be considered in the differential diagnosis of hoarseness, particularly when it appears suddenly. Thoracic endovascular aortic repair is a feasible option for those patients with penetrating aortic ulcer or pseudoaneurysm located in the aortic arch.
摘要：
背景奥特纳综合征，或者心脏综合征，是继发于心血管原因的左喉返神经麻痹。主动脉假性动脉瘤是一种罕见的危及生命的疾病，由主动脉壁的弱化引起。主动脉假性动脉瘤的临床表现变化很大。声音嘶哑通常是由良性疾病引起的；然而，它可能是需要立即诊断和治疗的潜在严重疾病的第一个症状。病例报告我们报告了一系列2例以突发性声音嘶哑为首发症状的主动脉弓假性动脉瘤患者。两个男人,年龄分别为76岁和60岁，几周前突然声音嘶哑。喉镜检查均显示左声带麻痹。计算机断层扫描（CT）扫描显示位于主动脉弓的胸主动脉假性动脉瘤压迫左喉返神经。两名患者均接受了腔内主动脉修复术。首例患者接受了颈动脉-锁骨下动脉分流术,左锁骨下动脉用血管塞装置封闭。一周后他出院了,持续的声音嘶哑。在第二种情况下，锁骨下动脉闭塞和用弹簧圈栓塞假性动脉瘤。控制CT扫描确认程序成功。然而,经过最初的有利进化，患者出现严重的非血管并发症,最终死亡.结论考虑到这2例病例和文献报道的病例，在鉴别诊断声音嘶哑时应考虑主动脉起源，特别是当它突然出现的时候。对于穿透性主动脉溃疡或位于主动脉弓的假性动脉瘤的患者，胸腔血管内主动脉修复术是一种可行的选择。
