CTICasesSquamous Cell Carcinoma of the Lung with Recurrent Laryngeal and Phrenic Nerve Invasion
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Imaging findings
A large mediastinal mass in the AP window region, which was pet-avid. PET-CT showed intense uptake in the right vocal cord (physiologic uptake from talking) but absolutely no uptake in the left vocal cord, indicating left vocal cord paralysis due to recurrent laryngeal nerve involvement. The mass also invaded the left phrenic nerve.
Key takeaways
This case demonstrated a nice physiologic metabolic correlation between recurrent laryngeal nerve palsy and absent FDG uptake in the ipsilateral vocal cord on PET. Pathologists found it hard to differentiate between thymic carcinoma and mediastinal squamous cell carcinoma. The tumor's location in the AP window explained the recurrent laryngeal nerve involvement, and it also invaded the phrenic nerve.
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