Mediastinal Lung Cancer in a Patients Presenting with Vocal Cord Paralysis

Abstract

Differential diagnosis of patients who present with vocal cord paralysis can be difficult. We describe a patient who presented with vocal cord paralysis, which lead to a diagnosis of mediastinal lung cancer.
The patient, a forty-seven-year-old female, complained of laryngeal pain and hoarseness. A detailed examination revealed paralysis of the right vocal cord, but did not uncover weight loss, pharyngeal and laryngeal tumors, and cervical lymphadenopathy. Plain computed tomography (CT) showed small thyroid nodules and small lymphadenitis in the subclavicular fossa and mediastinum, but was otherwise indefinite. Positron emission tomography (PET) CT undertaken a month after the initial presentation showed a rapid increase in the size of the esophageal and mediastinal nodules, multiple lymph nodes and distant metastases. Gastrointestinal fiberscopy did not reveal esophageal cancer. Based on PET-CT, GIF and neck nodule fine needle aspiration findings, she was diagnosed with mediastinal lung cancer. Chemotherapy was commenced, and the clinical course was good.
Mediastinal symptoms including vocal cord paralysis and superior vena cava syndrome can be primary symptoms of mediastinal lung cancer. Otolaryngologists should consider mediastinal lung cancer in the differential diagnosis of patients presenting with mediastinal symptoms.