Case 297

Hoarseness / Vocal Cord Paralysis

This radiology case explores the cause of hoarseness in a patient, ultimately diagnosed as vocal cord paralysis due to skull base metastasis.

CT Imaging Overview:

• Axial and Coronal Contrast-Enhanced CT (CECT) show:
  • Dilation of the laryngeal ventricle (sail sign)
  • Atrophy and medialization of the true vocal cord
  • Loss of the subglottic arch
  • Thickening of the aryepiglottic fold
  • Anteromedial displacement of the arytenoid cartilage
  • Contralateral subglottic air (mushroom sign)
• Bone window CT demonstrates possible skull base lesion, supporting metastatic spread affecting cranial nerves.

Diagnostic Insight:

These findings are characteristic of vocal cord paralysis, with imaging suggesting cranial nerve X (vagus) involvement at the skull base, possibly due to metastasis. The case underscores the importance of examining the jugular foramen, carotid space, and mediastinum for causative pathology.

Case courtesy of Remy Lobo, MD
University of Michigan, University of Utah