CT
The CT study shows left-sided unilateral vocal cord paralysis evidenced by abduction of the left vocal cord accompanied by enlarged pyriform sinus and ipsilateral laryngeal ventricle, creating the so-called "sail sign" and compensatory medial bowing of the right cord, with no evidence of sizeable masses or enlarged suspicious cervical lymph nodes. The examined mediastinum shows severe dilatation of the pulmonary trunk and main pulmonary arteries (the pulmonary trunk reaches 41 mm in axial diameter, compared to 20 mm maximum aortic diameter at the same level) with no evidence of sizeable mediastinal masses or suspicious mediastinal lymphadenopathy.
An atrial septal defect was noted as the cause of the right heart overload and severe dilatation of the pulmonary arterial system.