Presentation
Patient came for evaluation of left vocal cord palsy.
Patient Data
Evident superior mediastinal widening (13cm) even significant in a magnified anteroposterior projection.
Classically described findings of left vocal cord palsy
- medialization of left vocal cord.
- ipsilateral ventricle/pyriform sinus dilatation.
Large aneurysm of the arch of aorta with thick peripheral thrombus. There is accompanying extensive intimal medial calcification in the thoracic aorta as well the major branches extensively involving both common carotid arteries.
Moderate left pleural effusion.
Nodular thyroid gland more on the left side.
No supraglottic / glottic / subglottic mass lesions.
Case Discussion
Superior thoracic masses causing extrinsic impingement or infiltration of the vagus nerve can result in ipsilateral vocal cord weakness and has to be ruled out with the help of CT. In this patient the long standing aortic arch aneurysm might be the etiology.
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