Tuberculous mediastinal lymphadenopathy can cause left vocal cord paralysis

Anthracosis, a Distinct Cause of Vocal Fold Paralysis: Case Series

Vocal fold paralysis (VFP) can happen in various conditions due to mediastinal LADs, however no study has proposed anthracosis as an etiology. Here we discussed the chest CT features of anthracosis related LADs causing VFP. Among 41 cases of pulmonary anthracosis, 10 had VFP that all were presented with hoarseness. The paralysis was unilateral (left side) in all cases. Extra-nodal infiltration and conglomeration of lymph nodes were significantly higher in patients with paralysis. Left paratracheal, pre-vascular, and aortopulmonary window lymph nodes were seen in all patients. We propose that mediastinal LADs secondary to anthracosis could be a reason for left side VFP.

Tubercular Mediastinal Lymphadenopathy Presenting as an Isolated Unilateral Vocal Cord Palsy and the "Sail" Sign

Tuberculosis continues to remain a major public health challenge, especially in low- and middle-income countries. Unilateral vocal cord palsy in adults as the sole manifestation of tubercular mediastinal lymphadenopathy has been rarely reported. A 22-year-old lady presented with a history of hoarseness of voice for the past month. The general physical examination revealed palpable lymph nodes in the left axilla. Axial CT sections at the level of the vocal cords demonstrated dilation of the right laryngeal ventricle and mild anteromedial deviation of the ipsilateral arytenoid cartilage ("sail" sign) suggestive of a right vocal cord palsy. Contrast-enhanced CT chest revealed right paratracheal, right hilar, and subcarinal lymph nodes with areas of central necrosis. She was started on anti-tubercular therapy and her voice completely improved after three months of treatment. The "Sail" sign on axial CT scans is a useful radiological sign for diagnosing unilateral vocal cord palsy. Rarely, compression of the recurrent laryngeal nerve by enlarged mediastinal lymph nodes due to tuberculosis can present with unilateral vocal cord palsy as the sole manifestation in adults.

Tuberculous mediastinal lymphadenopathy presenting with left vocal cord palsy: A rare entity

A 23-year-old-male student, never-smoker presented to our hospital outpatient department with complaints of loss of appetite, unintentional weight loss, fatigue and low-grade fever for two months, hoarseness of voice (HOV) for two weeks. He was evaluated for HOV with video laryngoscopy which demonstrated left vocal cord palsy. Contrast enhanced CT Chest (CECT) was performed for evaluation of mediastinal lesions which revealed multiple peripheral enhancing conglomerate mediastinal lymph nodes. EBUS-trans bronchial needle aspiration (TBNA) and endobronchial biopsy were performed and specimens sent for smear and culture for AFB, Xpert MTB/RIF assay and histopathology. Results were consistent with Mycobacterium tuberculosis (MTB) infection and culture was positive for M. tuberculosis complex. Patient had been started on anti tubercular therapy (ATT) and during his 4th month follow up he showed clinicoradiological improvement without recovery of recurrent laryngeal nerve palsy.

Fetal rhabdomyoma of the tongue in a newborn

Anthracotic pigmentation in the bronchial mucosa is a bronchoscopic finding of pneumoconiosis, or evidence of heavy atmospheric soot. This pigmentation in the tracheobronchial mucosa is surrounded by calcified or noncalcified lymph nodes. Anthracosis is not a previously known cause of left vocal fold paralysis. We present what we believe to be the first reported case of anthracosis-caused vocal fold paralysis.

Unusual cause of bilateral vocal cord paralysis

The most common cause of vocal cord paralysis (VCP) as a result of recurrent laryngeal nerve compression is malignant tumors. A benign and inflammatory causes of VCP is rarely reported in the literature, and in almost all reported cases it was a unilateral paralysis. We report a rare case of tuberculous mediastinal lymphadenopathy causing bilateral VCP in a young female patient.

Right Gaze Palsy and Hoarseness: A Rare Presentation of Mediastinal Tuberculosis with an Isolated Prepontine Cistern Tuberculoma

We describe a previously healthy young man who presented with headaches, diplopia with right lateral gaze palsy, dysphagia, and hoarseness over a 2-month period. Magnetic resonance imaging of the brain revealed a small enhancing mass at the prepontine cistern and chest CT showed a left mediastinal mass. Mediastinoscopy and lymph node biopsy were performed. DNA probe and culture of the biopsy specimen were confirmed to be Mycobacterium tuberculosis complex. Resolution of neurologic symptoms was noted after 6 weeks, in addition to regression of brain stem and mediastinal lesions after 12 weeks of antituberculous therapy.

CT evaluation of vocal cord paralysis due to thoracic diseases: a 10-year retrospective study

PURPOSE

To discuss computed tomography (CT) evaluation of the etiology of vocal cord paralysis (VCP) due to thoracic diseases.

MATERIALS AND METHODS

From records from the past 10 years at our hospital, we retrospectively reviewed 115 cases of VCP that were evaluated with CT. Of these 115 cases, 36 patients (23 M, 13 F) had VCP due to a condition within the thoracic cavity. From these cases, we collected the following information: sex, age distribution, side of paralysis, symptom onset date, date of diagnosis, imaging, and primary disease. The etiology of VCP was determined using both historical information and diagnostic imaging. Imaging procedures included chest radiograph, CT of neck or chest, and esophagography or esophagoscopy.

RESULTS

Thirty-three of the 36 patients with thoracic disease had unilateral VCP (21 left, 12 right). Of the primary thoracic diseases, malignancy was the most common (19, 52.8%), with 18 of the 19 malignancies presenting with unilateral VCP. The detected malignant tumors in the chest consisted of thirteen lung cancers, three esophageal cancers, two metastatic tumors, and one mediastinal tumor. We also found other underlying etiologies of VCP, including one aortic arch aneurysm, five iatrogenic, six tuberculosis, one neurofibromatosis, three benign nodes, and one lung collapse. A chest radiograph failed to detect eight of the 19 primary malignancies detected on the CT. Nine patients with lung cancer developed VCP between follow-ups and four of them were diagnosed with a progression of malignancy upon CT evaluation of VCP.

CONCLUSION

CT is helpful for the early detection of primary malignancy or progression of malignancy between follow-ups. Moreover, it can reveal various non-malignant causes of VCP.

Sarcoidosis presenting as bilateral vocal fold paralysis

Sarcoidosis with cranial polyneuritis and mediastinal granulomatous compression as a cause of unilateral left vocal fold paralysis has been reported infrequently. No case of sarcoidosis causing bilateral vocal fold paralysis in the abducted position has been reported in the Otolaryngology/Voice literature. Vocal fold function can be impacted in sarcoidosis by direct laryngeal involvement or by neural pathways. In the patient described in this case, sarcoid cranial polyneuritis coupled with bilateral paratracheal and mediastinal adenopathy resulted in bilateral vocal fold paralysis. This patient had a dramatic response to treatment with steroids. Sarcoidosis should be included in the differential diagnosis of unilateral or bilateral vocal fold paralysis.

Tuberculous lymphadenopathy of superior mediastinum causing vocal cord paralysis

Vocal cord paralysis because of involvement of recurrent laryngeal nerve by benign and acute inflammatory lymphadenopathy is a rare condition. Presented here is a case of tuberculous lymphadenopathy of superior mediastinum causing left recurrent laryngeal nerve paralysis, which was successfully treated by antituberculosis treatment, with complete recovery of vocal cord function.

Replacement of one lung by a large bulla in active tuberculosis

A 70-year-old diabetic man with pulmonary tuberculosis developed a progressively enlarging bulla which occupied the whole left hemithorax and caused some shift of the mediastinum.

Sarcoidosis presenting as recurrent left laryngeal nerve palsy

A patient with sarcoidosis presented with hoarseness caused by mediastinal lymph nodes compressing the left recurrent laryngeal nerve. The response to corticosteroids was dramatic and complete.