CT evaluation of vocal cord paralysis due to thoracic diseases: a 10-year retrospective study

Abstract

Purpose: To discuss computed tomography (CT) evaluation of the etiology of vocal cord paralysis (VCP) due to thoracic diseases.

Materials and methods: From 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.

Results: Thirty-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.

Conclusion: CT 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.

Fig. 1

A 72-year-old woman with a paralyzed left vocal cord. Contrast-enha-nced CT demonstrates a large lung cancer in the left upper lobe with invasion in the aorticopulmonary window (arrows). CT, computed tomography.

Fig. 2

A 61-year-old woman with a paralyzed left vocal cord for 11 years. (A and B) Chest radiograph (A) and contrast-enhanced CT (B) show the left lung destroyed from pulmonary tuberculosis with a marked decrease in lung volume and a mediastinal shift to the left. Fibrocalcific tuberculous scars can be seen in the right upper lobe. CT, computed tomography.

Fig. 3

A 73-year-old woman with a paralyzed right vocal cord after failure of a chemo port insertion. (A and B) Contrast-enhanced CT scans demonstrate cellulitis in the right anterior chest wall along the tract of a previous chemo port (arrows) (A) and right upper mediastinitis (arrows) (B). CT, computed tomography.

Fig. 4

A 73-year-old man with paralyzed left vocal cord. (A) Contrast-enhanced CT prior to vocal cord paralysis demonstrates an irregular lung cancer (short arrow) in the apicoposterior segment of the left upper lobe and conglomerated metastatic nodes (long arrow) in the aortopulmonary window. (B) Follow-up CT after development of left vocal cord paralysis shows enlargement of a lung cancer (short arrow) and metastatic nodes in the aortopulmonary window (long arrow). CT, computed tomography.

Fig. 5

A 61-year-old man with a paralyzed right vocal cord. (A) Contrast-enhanced CT demonstrates a small irregular lung cancer in the right apex (white arrow) and a metastatic node in the right upper paratracheal region (black arrow). (B) Retrospective review of chest radiograph suggests a hidden mass being overlapped by the medial end of the right first rib (arrow). CT, computed tomography.