ACUTE ONSET OF HOARSENESS OF VOICE IN A MIDDLE AGED MALE PATIENT Jane A. Ball, Jagan D. Gupta MD Neel D. Gupta MD Jeremy B. Nguyen MD
HISTORY 56 year - old male presents with acute onset of hoarseness of voice. Patient states that he has had generalized weakness, difficulty swallowing, and mild gradual unintentional weight loss over the past 6 months.
Figure 1 Axial CT with contrast
Figure 2 Axial CT with contrast
Figure 3 Coronal CT with contrast
Figure 4 Axial CT with contrast
Figure 5 PET/CT fusion
Figure 4 Axial CT with contrast
Figure 6 Axial CT with contrast
Figure 7 PET/CT Fusion
IMAGING FINDINGS Figure 1 demonstrates ipsilateral dilatation of the right laryngeal ventricle (yellow arrow). Figure 2 and 3 demonstrate asymmetrical thickening and medialization of the right aryepiglottic fold (yellow arrow) and asymmetrical ipsilateral dilatation of the right piriform sinus (green arrow). Figures 4 and 5 demonstrate a heterogeneous soft tissue mass consistent with conglomerate mediastinal lymphadenopathy centered with the right paratracheal space extending superiorly to intimately involve the right recurrent laryngeal nerve (yellow arrow), the mass also exhibits marked increased metabolic activity on PET/CT fusion images (red arrow). Figures 6 and 7 show circumferential soft tissue thickening of the distal esophagus demonstrating increasedmetabolic activity on CT (yellow arrow) and PET/CT fusion images (red arrow)
DIFFERENTIAL DIAGNOSIS 1. Metastatic Primary Esophageal Neoplasm with Right Paratracheal/Mediastinal Metastatic Lymphadenopathy affecting the Right Recurrent Laryngeal Nerve resulting in Unilateral Vocal Cord Paralysis
2. Lymphoma
3. Unilateral Vocal Cord Paralysis/Paresis in the Setting of Prolonged Intubation.
4. Reactive Mediastinal Lymphadenopathy
5. Thyroid Goiter versus Thyroid lesion
6. Vascular Lesion such as Thoracic Aortic Aneurysm
7. Sarcoidosis
18 J LA MED SOC | VOL 173 | WINTER 2021
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