Author(s)
Meryam Shikara, MD1
Steven Cassady, MD2,3
Mrinalini Krishnan, MD4
Shiavax J. Rao, MD5
Gautam Ramani, MD3,6
Elizabeth Guardiani, MD1,3
Affiliation(s)
1 . Department of OTO-HNS, University of Maryland Medical System, Baltimore, MD 2 . Department of Pulmonary Critical Care, University of Maryland Medical System, Baltimore, MD 3 . University of Maryland School of Medicine, Baltimore, MD 4 . Department of Cardiology, MedStar Heart and Vascular Institute, Washington, DC 5 . Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD 6 . Department of Cardiology, University of Maryland Medical System, Baltimore, MD
Abstract:
Objectives:
To describe rare presentations of left vocal fold paralysis (LVFP) caused by pulmonary hypertension (PH).
Methods: Case series
Results:
Three women in their 30s and 40s presented to the Otolaryngology clinic for new onset hoarseness. All three women underwent videostroboscopy and were diagnosed with left vocal fold paralysis. CT of the neck and chest with contrast was performed in each patient which revealed dilation of the PA and no other abnormalities along the left recurrent laryngeal nerve (RLN). In one patient the diagnosis of idiopathic pulmonary arterial hypertension (IPAH) was already known and in the other two patients this led to a new diagnosis of pulmonary hypertension (PH). One patient had a distant history of heart surgery as a child for hypertrophic cardiomyopathy but no history of hoarseness following that surgery. All patients underwent treatment for the PH but no patient had documented recovery of vocal fold motion. One patient underwent injection augmentation with subsequent improvement in voice, one patient reported subjective improvement of her voice after treatment of the PH and the other decided to defer treatment for her voice.
Conclusions:
LVFP caused by compression of the left RLN as it courses through the aortopulmonary window is a rare complication of pulmonary hypertension. It is important to recognize PH as a potential cause of idiopathic UVFP and order appropriate chest imaging to facilitate early diagnosis and referral to cardiology.