Lessons of the month: A forgotten classic: Delayed diagnosis of mitral stenosis presenting initially as Ortner's syndrome.

Clinical Medicine : Journal of the Royal College of Physicians of London
Raja Ef Raja ShariffSazzli S Kasim

Abstract

We present a rare case of delayed diagnosis of mitral stenosis, initially presenting with hoarseness in her voice due to left recurrent laryngeal nerve (LRLN) compression. A 60-year-old woman presented to the otorhinolaryngology department following complaints of progressive hoarseness in voice over a 6-month period. There was dysphonia but no additional evidence of a cranial nerve IX or X palsy on examination, with subsequent flexible nasopharyngolaryngoscopy demonstrating left vocal cord palsy. She was referred for a cardiology consult following findings of atrial fibrillation on electrocardiography. Transthoracic echocardiography revealed an enlarged left atrium with evidence of severe mitral stenosis. A diagnosis of Ortner's syndrome was made and the patient underwent mitral valve replacement. Common causes of Ortner's syndrome include mitral stenosis with left atrium compression of the LRLN, but it can occur due to other causes including pulmonary hypertension or aortic aneurysm compression, among others. There are few data at present to conclude that regression of left atrial enlargement and pulmonary arterial hypertension with symptoms are associated with Ortner's syndrome. Therefore, it remains pertinent for clinicians ...Continue Reading

References

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Feb 4, 2006·Vascular and Endovascular Surgery·José F Guijarro EscribanoRafael Fernández Antón
Sep 15, 2009·Lancet·Y ChandrashekharJagat Narula
Oct 28, 2011·Brazilian Journal of Otorhinolaryngology·Vijayalakshmi SubramaniamMuhammad Thahir
Mar 1, 2019·Current Cardiology Reports·Nina C WunderlichRobert J Siegel

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Citations

Mar 26, 2021·Clinical Medicine : Journal of the Royal College of Physicians of London·Oscar Jolobe

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