title: Ortner's syndrome presenting as thoracic aortic aneurysm mimicking thoracic malignancy: a case report.
abstract: BACKGROUND
  Ortner's syndrome is defined as left recurrent laryngeal nerve palsy caused by a cardiovascular pathology. Here we report the case of a 68-year-old man who presented to our hospital with hoarseness, whose initial chest imaging mimicked a thoracic neoplastic process with left pleural effusion. The final diagnosis was Ortner's syndrome due to the silent rupture of a thoracoabdominal aortic aneurysm. Diagnostic thoracentesis, before computed tomography, in resource-poor settings, may have resulted in an adverse outcome in our case.
  
  
  METHODS
  A 68-year-old Sri Lankan man was referred to us by an otolaryngologist for further evaluation of a suspected thoracic malignancy. His presenting symptom was hoarseness of three months duration. He had essential hypertension for the last four years and had a history of 25 pack-years of cigarettes smoking. His chest X-ray showed a left-sided mediastinal mass with mild to moderate pleural effusion. An ultrasound appeared to show an encysted pleural fluid collection. However, we proceeded with computed tomography before diagnostic thoracentesis. The diagnosis of Ortner's syndrome was made after the computed tomography due to the silent rupture of his thoracoabdominal aortic aneurysm.
  
  
  CONCLUSIONS
  Hoarseness due to left recurrent laryngeal nerve palsy can be the presenting symptom of cardiovascular pathologies, Ortner's syndrome. Silent rupture of thoracic aortic aneurysms can mimic that of thoracic malignancy, which is reported in literature. We illustrate the importance of a high degree of suspicion of cardiovascular pathology in order to avoid an adverse outcome following diagnostic thoracentesis.
authors.affiliation: Department of Respiratory Medicine, National Hospital for Respiratory Diseases, Negombo Road, Welisara, Sri Lanka. mailtoupul@gmail.com.
authors.forename: Upul
authors.initials: U
authors.lastname: Pathirana
authors.affiliation: Department of Respiratory Medicine, National Hospital for Respiratory Diseases, Negombo Road, Welisara, Sri Lanka. kularatnesaman@yahoo.co.in.
authors.forename: Saman
authors.initials: S
authors.lastname: Kularatne
authors.affiliation: Department of Thoracic Surgery, National Hospital for Respiratory Diseases, Negombo Road, Welisara, Sri Lanka. handagala@yahoo.com.
authors.forename: Sumana
authors.initials: S
authors.lastname: Handagala
authors.affiliation: Department of Cardiothoracic Surgery, National Hospital of Sri Lanka, E W Perera Mawatha, Colombo 10, Sri Lanka. gaminiranasinghe@hotmail.com.
authors.forename: Gamini
authors.initials: G
authors.lastname: Ranasinghe
authors.affiliation: Department of Radiology, General Hospital (Teaching), Peradeniya Road, Kandy, Sri Lanka. ravi.samarasinghe@gmail.com.
authors.forename: Ravinda
authors.initials: R
authors.lastname: Samarasinghe
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D008297:Male; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D014826:Vocal Cord Paralysis / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging