CTICasesRecurrent Laryngeal Nerve Paralysis (Hoarseness) due to Small Cell Lung Cancer
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Imaging findings
CT of the chest showed involvement of the aortopulmonary (AP) window region, which is anatomically close to the lower recurrent laryngeal nerve. When the chest CT extended to include the true vocal cords, findings of vocal cord paralysis were noted, characterized by the normal vocal cord appearing in the midline (or even crossing midline to compensate) while the paralyzed cord was abnormal, and a 'sail sign' was present in the laryngeal ventricle on the affected side.
Key takeaways
Small cell lung cancer, particularly with involvement of the aortopulmonary window, is a common cause of recurrent laryngeal nerve paralysis, resulting in hoarseness. This case highlights the importance of recognizing the different appearances of vocal cord paralysis on neck CT (usually performed during shallow inspiration) versus chest CT (typically performed during end inspiration). The characteristic 'sail sign' in the laryngeal ventricle is a key finding.
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