Vocal cord paralysis: anatomical correlation and review of imaging findings.

Transcription

1 Vocal cord paralysis: anatomical correlation and review of imaging findings. Poster No.: C-1019 Congress: ECR 2011 Type: Educational Exhibit Authors: E. Gomez 1, A. Quiles 1, M. Tobed 2, F. Reina de la Torre 1, S. Keywords: DOI: Pedraza 3 ; 1 Girona/ES, 2 girona/es, 3 GIRONA/ES Neoplasia, Abscess, Diagnostic procedure, CT, Thorax, Neuroradiology peripheral nerve, Head and neck /ecr2011/C-1019 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 13

2 Learning objectives To review the anatomy of the vagus nerve (X CN) and its branches. To recognize CT findings associated to vocal cord paresis/palsy (VCP). To comment on the different causes and locations in compressive/infiltrative diseases. Background The recurrent laryngeal nerves (RLNs) innervate the laryngeal musculature and are involved in phonation. Injury to any point along the neural path from the medulla to RLN (ppt 1) usually results in vocal cord paresis and impaired vocal function. Vocal cord paresis and impaired vocal function can also be caused by intrinsic vocal cord lesions. Many cases of VCP will have traumatic/surgical, toxic, or unknown causes and imaging will be unable to identify a lesion. In other cases like neoplastic, inflammatory or cardiovascular disease, imaging will show the cause. Multidetector CT is the radiological technique of choice because it enables both the neck and the thorax to be studied correctly (ppt 2). Only the cisternal portion of the vagus nerve can be evaluated. Images for this section: Page 2 of 13

3 Fig. 1: ppt 1. Anatomy: from medulla to recurrent nerves Page 3 of 13

4 Fig. 2: ppt 2. Technique Page 4 of 13

5 Imaging findings OR Procedure details The typical radiological findings of PVC are: Medialization of the vocal cord, absence of movement with phonatory techniques and dilatation of the ipsilateral laryngeal ventricle (ppt 3). The cause of vocal cord paralysis can be identified by imaging, mainly by CT (ppt4): a) Central pathology, b) Peripheral nerve: main trunk (ppt 5) and recurrent nerves at the level of neck (Laterocervical adenopathies, lesions of the great cervical vessels and paraganglioma like tumors, thyroid and parathyroid pathology) (ppt 6) or thorax (Cardiovascular disease, lung or mediastinal tumors) (ppt 7). c) Vocal cord lesions (ppt 8). Images for this section: Page 5 of 13

6 Fig. 1: ppt3. Vocal cord palsy semiology Page 6 of 13

7 Fig. 2: ppt 4. Causes Page 7 of 13

8 Fig. 3: ppt 5. Vagus trunk pathology Page 8 of 13

9 Fig. 4: ppt 6. Recurrent nerve affectation Page 9 of 13

10 Fig. 5: ppt 7. Thoracic causes Page 10 of 13

11 Fig. 6: ppt 8. Intrinsic laryngeal Page 11 of 13

12 Conclusion Vocal cord palsy is a frequent symptom that can be related to multiple etiologies and sites. CT can help to diagnose or confirm the paralysis and also to identify the causal lesion. Personal Information Eva Gómez Roselló Neuroradiology Section. Hospital Trueta. Girona. evagrosello@hotmail.com References Hansberger. Imaging anatomy. Ed Amirsis, Hansberger. Diagnostic Imaging : Head and neck. Ed Amyrsis, Henrot P, Blum A, Toussaint B, Troufleau P, Stines J, Roland J. Dynamic maneuvers in local staging of head and neck malignancies with current Imaging techniques: principles and clinical applications. Radiographics Sep-Oct;23(5): Chin SC, Edelstein S, Chen CY, Som PM. Using CT to localize side and level of vocal cord parálisis. AJR Am. J Roentgenol Apr;180(4): Glazer HS, Aronberg DJ, Lee Jk, Sagel SS. Extralaryngeal causes of vocal cord paralysis: CT evaluation. AJR Am J Roentgenol Sep;141(3): Komissarova M, Wong KK, Piert M, Mukherji SK, Fig LM. Spectrum of 18F-FDG PET/CT findings in oncology-related recurrent laryngeal nerve palsy. AJR Am J Roentgenol Jan;192(1): Page 12 of 13

13 Mukherji SK. Cranial nervies. Neuroimaging clinics of North America May, vol 18 (2): Kelly BE, Brooker DS. Ortner's syndrome: a radiological diagnosis. Ulster Med J May;71(1):55-6. Phua GC, Eng PC, Lim SL, Chua YL. Beyond Ortner's syndrome--unusual pulmonary complications of the giant left atrium..ann Acad Med Singapore Nov;34(10): Archana B. Rao, MD. Paragangliomas of the head and neck: Radiologic-Pathologic correlation. Radiographics 1999; 19: Sobin LH, Gosparowicz M, Wittekind C. TNM classification of malignant tumours (UICC). Ed Wiley, Page 13 of 13