Anatomic laryngeal landmarks Pathways of vagus and recurrent laryngeal nerves CT features of vocal cord paralysis Causes of recurrent laryngeal nerve paralysis

Vocal cord paralysis (VCP) is the loss of mobility of the true vocal cords secondary to a mechanical cause infiltrating the glottis or a neural lesion affecting the vagus (CN X) or recurrent laryngeal nerves (RLN). These nerves provide motor innervation to the intrinsic muscles of the larynx and travel a long distance from the skull base into the upper mediastinum. Most cases of VCP are unilateral due to a compressive mass, although up to 1/3 may be bilateral. VCP can be classified in central...

DIAGNOSTIC ASESSMENT Once VCP is suspected, patients must undergo a clinical evaluation of the larynx followed by a thorough head and neck radiological evaluation. Cross sectional imaging modality of choice is CECT. The study must include the upper mediastinum up to the aortopulmonary window and acquired during quiet respiration so the cords are in an abducted position. Both the CN X and RLN cannot be directly visualized on CT, therefore, it is imperative for radiologists to recognize their expected courses so we dont miss out...

Vocal cords participate in major functions such as breathing, phonation and swallowing, nonetheless, almost half of patients with VCP are asymptomatic and one third of VCP have an underlying malignancy.The rising number of CT scans performed in our daily practice makes it imperative for radiologists to be aware that the imaging findings often precede the clinical manifestations of VCP so the challenge consists on developing a keen-sighted approach to early detecting VCP and the importance of looking below the clavicles for potential causes.

A. Micolich Vergara: Nothing to disclose J. Capellades: Nothing to disclose F. Zuccarino: Nothing to disclose

Kwong, Y., Boddu, S., & Shah, J. (2012). Radiology of vocal cord palsy.Clinical radiology,67(11), 1108–1114. https://doi.org/10.1016/j.crad.2012.03.008 Paquette, C. M., Manos, D. C., & Psooy, B. J. (2012). Unilateral vocal cord paralysis: a review of CT findings, mediastinal causes, and the course of the recurrent laryngeal nerves.Radiographics : a review publication of the Radiological Society of North America, Inc,32(3), 721–740. https://doi.org/10.1148/rg.323115129 Méndez Garrido, S., & Ocete Pérez, R. F. (2016). Causes and imaging manifestations of paralysis of the recurrent laryngeal nerve. Manifestaciones en imagen y causas...