This 61 y/o man was sent to our office by ENT for w/up of a vocal cord paralysis. He has had subacute-onset hoarseness for the past 2-3 months and ENT found a unilateral R vocal cord paralysis. He did a CT (see the images below), which only showed some mediastinal and hilar (R>L) adenopathy much of which is calcified.
He has had a PET scan which showed some very faint (SUV<4) style="display: block; text-align: center;" alt="" src="http://photos1.blogger.com/x/blogger/7040/842/320/933316/Vocal.jpg" border="0">
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4 comments - CLICK HERE to read & add your own!:
How can you be sure that this is due to impingement on recurrent laryngeal nerve?
I guess that is my question. I really can't be sure. We have not found any malignancy or large tumors along the way and the hoarseness is new so the paralysis is also new.
What would you do next for work up?
Like you, I suspect there is fibrosing mediastinits--you don't have to have evidence of "massive" disease- just some fibrosis in the wrong place.
The only way to know definitively would be with a biopsy.
Has anyone scoped his GI tract to R.O esophageal disease?
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