Indian Journal of Nuclear Medicine
Home | About IJNM | Search | Current Issue | Past Issues | Instructions | Ahead of Print | Online submissionLogin 
Indian Journal of Nuclear Medicine
  Editorial Board | Subscribe | Advertise | Contact
Users Online: 88 Print this page  Email this page Small font size Default font size Increase font size


 
 Table of Contents     
INTERESTING IMAGE
Year : 2021  |  Volume : 36  |  Issue : 2  |  Page : 212-213  

Ortner's syndrome associated with takayasu's aortoarteritis identified on fluorodeoxyglucose positron-emission tomography/computed tomography


Department of Nuclear Medicine, MIOT International, Chennai, Tamil Nadu, India

Date of Submission30-Sep-2020
Date of Decision13-Oct-2020
Date of Acceptance14-Oct-2020
Date of Web Publication21-Jun-2021

Correspondence Address:
Dr. Piyush Chandra
Department of Nuclear Medicine, MIOT International, Manapakkam, Chennai - 600 056, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.ijnm_205_20

Rights and Permissions
   Abstract 


Cardiovocal syndrome or Ortner's syndrome is hoarseness voice due to left recurrent laryngeal nerve palsy secondary to nerve compression caused by enlarged cardiovascular structures in the mediastinum. We present here an interesting positron-emission tomography/computed tomography image of a patient suspected to have Takayasu's aortoarteritis and presenting with hoarseness of voice.

Keywords: Aneurysm, aortoarteritis, cord, fluorodeoxyglucose, palsy, positron-emission tomography/computed tomography, saccular, Takayasu's


How to cite this article:
Chandra P, Nath S. Ortner's syndrome associated with takayasu's aortoarteritis identified on fluorodeoxyglucose positron-emission tomography/computed tomography. Indian J Nucl Med 2021;36:212-3

How to cite this URL:
Chandra P, Nath S. Ortner's syndrome associated with takayasu's aortoarteritis identified on fluorodeoxyglucose positron-emission tomography/computed tomography. Indian J Nucl Med [serial online] 2021 [cited 2021 Jul 27];36:212-3. Available from: https://www.ijnm.in/text.asp?2021/36/2/212/318876



A 41-year-old female presented with chest pain/hoarseness of voice for 6 months. Laboratory investigations revealed only raised erythrocyte sedimentation rate-83 mm in the 1st h and raised C-reactive protein 144.4 mg/l (normal: <10 mg/L). Videolaryngoscopy showed left vocal cord palsy. Volume-rendered three-dimensional computed tomography (CT) aortogram showed sacuular aneurysms involving the aortic arch and infrarenal abdominal aorta [Figure 1]a-yellow arrows]. Mild focal narrowing of the infrarenal aorta was noted just above the bifurcation. The rest of the aortogram was normal. Based on the clinical (no evidence of any pulseless disease) and imaging findings, the patient was diagnosed to have Takayasu's aortoarteritis (TAA) and was referred for positron-emission tomography/CT (PET/CT) for assessing baseline disease activity. Whole-body fluorodeoxyglucose (FDG) PET/CT [[Figure 1]b, black arrows] showed intense focal FDG uptake (Grade 3, SUVmax – 9.31, target-to-liver ratio – 2.66) in the wall of the partially thrombosed saccular aneurysm involving the aortic arch diameter of aneurysm: 4.6 cm and aneurysmal wall thickness: 6.4 mm [[Figure 1]c and [Figure 1]d-long white arrows] and low-grade FDG uptake (Grade 2, SUVmax – 4.24, target-to-liver ratio – 1.23) in the wall of the small saccular aneurysm in infrarenal abdominal aorta diameter of aneurysm: 1.6 cm and aneurysmal wall thickness: 7 mm [Figure 1e and f, short white arrows], with the total vascular score on PET/CT being 6 – suggestive of active vasculitis. Another abnormal finding in PET/CT was asymmetric reduced FDG uptake noted in the adducted left vocal cord consistent with left vocal cord palsy [Figure 1g and h, red arrows]. The patient was started on oral steroids and successfully underwent an endovascular stent grafting of the thoracic ductal aneurysm for impending rupture.
Figure 1: (a) Volume-rendered three-dimensional computed tomography aortogram showing saccular aneurysm in the arch and infrarenal aorta (yellow arrows). (b) Whole-body fluorodeoxyglucose positron-emission tomography Maximum intensity projection (MIP) image showing fluorodeoxyglucose uptake in these aneurysms. (c-f) Transaxial computed tomography and positron-emission tomography/computed tomography images showing fluorodeoxyglucose avid aortic wall thickening and saccular aneurysm in aortic arch and infrarenal aorta (white arrows). (g and h) Transaxial computed tomography and positron-emission tomography/computed tomography images showing adducted left vocal cord with loss of fluorodeoxyglucose uptake (suggestive of palsy) and physiological fluorodeoxyglucose uptake in the normal right vocal cord

Click here to view


Although aneurysm formation in TAA is not rare (seen in up to 2.8%–31.9% of the patients), symptomatic aneurysms as a presenting feature of this disease (as seen in this case) are exceedingly rare.[1],[2] This aneurysm formation is probably the result of marked degeneration of the tunica media of the artery and is claimed to be seen more commonly seen in the aorta with little calcification.[3] Risk of rupture of aneurysm related to TAA is very low and surgical repair is advised only if they are >5 cm in diameter.[4],[5] FDG PET/CT is increasingly gaining importance in diagnostic and prognostic assessment of large cell vasculitis.[6] In addition to CT angiography, PET/CT can assess/quantify the whole-body arterial inflammation burden and thereby can be useful for monitoring response to steroids in aneurysms which are managed conservatively.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Matsumura K, Hirano T, Takeda K, Matsuda A, Nakagawa T, Yamaguchi N, et al. Incidence of aneurysms in Takayasu's arteritis. Angiology 1991;42:308-15.  Back to cited text no. 1
    
2.
Sheikhzadeh A, Tettenborn I, Noohi F, Eftekharzedeh M, Schnabel A. Occlusive thromboaortopathy (Takayasu disease): Clinical and angio-graphic features and a brief review of literature. Angiology 2002;53:29-40.  Back to cited text no. 2
    
3.
Sueyoshi E, Sakamoto I, Hayashi K. Aortic aneurysms in patients with Takayasu's arteritis: CT evaluation. AJR Am J Roentgenol 2000;175:1727-33.  Back to cited text no. 3
    
4.
Subramanyan R, Joy J, Balakrishnan KG. Natural history of aortoarteritis (Takayasu's disease). Circulation 1989;80:429-37.  Back to cited text no. 4
    
5.
Giordano JM. Surgical treatment of Takayasu's disease. Cleve Clin J Med 2002;69 Suppl 2:SII146-8.  Back to cited text no. 5
    
6.
Pelletier-Galarneau M, Ruddy TD. PET/CT for diagnosis and management of large-vessel vasculitis. Curr Cardiol Rep 2019;21:34.  Back to cited text no. 6
    


    Figures

  [Figure 1]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
    References
    Article Figures

 Article Access Statistics
    Viewed136    
    Printed0    
    Emailed0    
    PDF Downloaded22    
    Comments [Add]    

Recommend this journal