CT Evaluation of Vocal Cord Paralysis due to Thoracic Diseases: A 10-Year Retrospective Study

Abstract

PurposeTo discuss computed tomography (CT) evaluation of the etiology of vocal cord paralysis (VCP) due to thoracic diseases.Materials and MethodsFrom records from the past 10 years at our hospital, we retrospectively reviewed 115 cases of VCP that were evaluated with CT. Of these 115 cases, 36 patients (23 M, 13 F) had VCP due to a condition within the thoracic cavity. From these cases, we collected the following information: sex, age distribution, side of paralysis, symptom onset date, date of diagnosis, imaging, and primary disease. The etiology of VCP was determined using both historical information and diagnostic imaging. Imaging procedures included chest radiograph, CT of neck or chest, and esophagography or esophagoscopy.ResultsThirty-three of the 36 patients with thoracic disease had unilateral VCP (21 left, 12 right). Of the primary thoracic diseases, malignancy was the most common (19, 52.8%), with 18 of the 19 malignancies presenting with unilateral VCP. The detected malignant tumors in the chest consisted of thirteen lung cancers, three esophageal cancers, two metastatic tumors, and one mediastinal tumor. We also found other underlying etiologies of VCP, including one aortic arch aneurysm, five iatrogenic, six tuberculosis, one neurofibromatosis, three benign nodes, and one lung collapse. A chest radiograph failed to detect eight of the 19 primary malignancies detected on the CT. Nine patients with lung cancer developed VCP between follow-ups and four of them were diagnosed with a progression of malignancy upon CT evaluation of VCP.ConclusionCT is helpful for the early detection of primary malignancy or progression of malignancy between follow-ups. Moreover, it can reveal various non-malignant causes of VCP.

Ascending aortic aneurysm causing hoarse voice: a variant of Ortner's syndrome: Figure 1

“…In previous case series of extralaryngeal vocal cord palsy investigated by CT, only 1/33,2 1/623 and 1/1154 cases were due to a cardiovascular cause. The most common cause of recurrent laryngeal nerve palsy in these series was superior mediastinal lymphadenopathy, most commonly due to malignancy.…”

Etiological profile of unilateral vocal cord paralysis: A single institutional experience over 10 years

“…Therefore, it would be cost-effective to scan down to the level of the aortic triangle when taking neck CT scans for patients with vocal cord palsy, regardless of the paralytic side. [15] CONCLUSION The most common cause of unilateral vocal cord palsy is idiopathic; nevertheless vocal cord palsy is a very important sign of various underlying diseases. A thorough evaluation, which must necessarily include CT neck and mediastinum, and diagnostic endoscopy when called for is essential before labeling a case as idiopathic.…”

Small cell lung cancer presenting with hoarseness

“…In the thorax, left recurrent laryngeal nerve is more vulnerable due to the longer route passing through the aortopulmonary window 3. In this case, clinical presentation of hoarseness due to unilateral left vocal cord paralysis could be a helpful clue for the diagnosis of lung cancer.…”