Chest
Volume 95, Issue 5, May 1989, Pages 1139-1140
Journal home page for Chest

Selected Reports
Hoarseness Secondary to Left Atrial Myxoma

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A 62-year-old woman presented with a history of hoarseness. Although stable for ten years, she recently showed signs of deterioration. Investigations revealed left vocal cord paralysis and a large left atrial tumor displacing the left pulmonary artery under the arch of the aorta. The lesion was removed and the normal aortopulmonary window on computed tomography (CT) scan was restored. On review of the literature, this case appears to be the first to suggest that myxomas cause recurrent laryngeal nerve palsy through direct effects.

Section snippets

CASE REPORT

A 62-year-old woman presented to a peripheral hospital complaining of a recent deterioration in her voice in the preceding six months. She had a ten-year history of hoarseness. A chest roentgenogram revealed left atrial enlargement consistent with mitral valve disease; however, an echocardiogram showed a large left atrial tumor.

The patient was referred to the Ottawa Heart Institute. An in-depth history taken there uncovered no other symptoms. Most notably, she suffered no dyspnea, episodes of

DISCUSSION

Atrial myxomas are the most common form of primary cardiac tumor, accounting for 50 percent of the benign tumors.2 They are generally solitary and pedunculated, arising from endothelial or subendocardial reserve cells in the fossa ovalis of the left atrium.3 Lobular and pale-gray atrial myxomas range in size from 0.4 to 8 cm, although they may grow as polypoid masses filling the entire cardiac chamber.4

History and physical examination alone rarely uncover myxomas, requiring two-dimensional

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Cited by (15)

  • Neurologic complications of cardiac tumors

    2014, Handbook of Clinical Neurology
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    Their review of the literature included a total of 16 cases of metastatic myxoma (including the case of Rankin and DeSousa (Desousa et al., 1978), but not the case of Kimbrell and Kaasa (1973)). Rubens et al. (1989) described a patient with a large left atrial myxoma that displaced the left pulmonary artery in such a way that it compressed the recurrent laryngeal nerve. Their patient presented with a long history of hoarseness and, on examination, had findings consistent with left recurrent laryngeal nerve palsy.

  • Cardiovocal Syndrome: A Systematic Review

    2008, Heart Lung and Circulation
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    Transcatheter approach for closure of PDA in a patient with long ductus and narrow diameter is associated with a higher risk for vocal cord palsy.10 Left atrial enlargement in association with giant thrombus,12 mitral stenosis,1 mitral valve prolapse,13 mitral regurgitation,14 and atrial myxoma15 has been described to cause LRLN palsy. The incidence of cardiovocal syndrome in mitral stenosis ranges from 0.6% to 5%.16

  • Ortner's syndrome: Case series and literature review

    2011, Brazilian Journal of Otorhinolaryngology
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    He deduced the cause to be compression of the left recurrent laryngeal nerve by an enlarged left atrium2. Since then various authors have recorded their experiences of recurrent laryngeal nerve involvement in various cardiac disorders such as Eisenmenger complex3, left ventricular failure4, atrial septal defect5, patent ductus arteriosus (PDA)6,7, primary pulmonary hypertension8-10 recurrent pulmonary artery embolism11, mitral regurgitation12, atrial myxoma13, left ventricular aneurysm14, cor pulmonale15 and various types of aortic aneurysms16-21. A number of authors have questioned the explanation offered by Ortner to the cause of vocal fold palsy.

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