CTICasesRecurrent Laryngeal Nerve Paralysis (Hoarseness) due to Lung Mass and Lymphadenopathy
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Imaging findings
Chest x-ray demonstrated a mass projecting over the left hilum, predominantly inferiorly, and a subtle convexity in the aortopulmonary (AP) window region. CT confirmed a large AP window mass, a posterior mass in the left lung, and additional hilar lymphadenopathy. Neck CT showed typical signs of unilateral vocal cord paralysis, including asymmetric enlargement of the piriform recess and a 'sail sign' with asymmetrically dilated laryngeal ventricle.
Key takeaways
Hoarseness can be a presenting symptom of recurrent laryngeal nerve paralysis, caused by compression or direct involvement of the nerve by thoracic masses, such as lung cancer or enlarged lymph nodes in the AP window. Characteristic imaging findings of vocal cord paralysis are discernible on neck CT, which is usually performed during shallow inspiration. These include specific asymmetries of the laryngeal structures.
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