Learning objectives
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The current exhibit aims to:
To assess the course of the vagus and recurrent laryngeal nerves (RLN).
To identify the reliable CT signs of unilateral Vocal Cord Paralysis (VCP) and avoid mimics and pitfalls.
To recognize the different etiology of unilateral VCP.
Background
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Vocal cord paralysis (VCP) due to recurrent laryngeal nerve (RLN) dysfunction is a frequent cause of hoarseness,
and may be secondary to several conditions along the vagus nerve pathway and its branches,
anywhere along its course,
from the brainstem to the inferior margin of the nerve.
Up to 40% of individuals with VCP may be asymptomatic [1].
Conversely,
VCP can be the initial signs of serious disease secondary to invasion or compression of the RLN.
Vocal...
Findings and procedure details
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Unilateral vocal cord paralysis is caused by a number of common and uncommon mediastinal disease entities and may be the presenting symptom of an otherwise clinically occult disease.
VCP is reliably identified at CT by recognizing key findings at the level of the true vocal cords.
The most sensitive signs on CT scans are ipsilateral piriform sinus dilatation,
medial rotation and thickening of the aryepiglottic fold and ipsilateral laryngeal ventricle dilatation.
I. CLINICAL FINDINGS
Usually,
patients...
Conclusion
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VCP may be caused by a number of common and uncommon disease entities and may be the presenting symptom of an otherwise clinically occult disease.
Considering that up to 35% of patients with vocal cord paralysis are asymptomatic,
the recognition of radiological findings indicative of this condition is essential for the radiologist who must warn the referring physician on the imaging findings.
VCP can be reliably identified at CT by recognizing key findings at the level...
References
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[1] Christina M.
Paquette,
MD,
Daria C.
Manos,
MD,
FRCPC • Brian J.
Psooy,
MD,
FRCPC.
Unilateral Vocal Cord Paralysis: A Review of CT Findings,
Mediastinal Causes,
and the Course of the Recurrent Laryngeal Nerves.
RadioGraphics 2012; 32:721–740
[2] Yumoto E,
Minoda R,
Hyodo M,
Yamagata T.Causes of recurrent laryngeal nerve paralysis.
Auris Nasus Larynx 2002;29(1):41–45.
[3] Merati AL,
Halum SL,
Smith TL.
Diagnostic testing for vocal fold paralysis: survey of practice and evidence-based medicine review....