Mediastinum Metastatic Tumor First Presented with Unilateral Vocal Fold Paralysis:A Caution to Clinicians

GUAN Jin; LI Jin-rang

doi:10.3969/j.issn.1002-3429.2014.10.008

Abstract：Objective To explore the etiology and diagnosis experience of unilateral vocal fold paralysis in the aged for improving the diagnosis rate. Methods The clinical data of an old male patient with mediastinum metastatic tumor first presen-ted with unilateral vocal fold paralysis was retrospectively reviewed. Results The patient with sudden hoarseness and choke and cough for 3 months was diagnosed with left vocal fold paralysis in local hospital. After treatment with neurotrophic drugs, the pa-tient had no improvement of symptoms and was admitted to our hospital. No positive findings were found in swallow esophago-gram, gastroscopy and ultrasonography of the neck and abdominal cavity. The patient was diagnosed with idiopathic unilateral vo-cal cord paralysis by laryngoscopes and chest X-ray. Then vocal fold augmentation by autologous fat injection was performed via suspension laryngoscope, and the patient was discharged after his symptoms basically disappeared. But four months later, the patient returned to hospital for cough and choke while eating. Combining the results of chest CT, neck ultrasonography and the aspiration biopsy of the left supraclavicular lymph nodes, the patient was finally diagnosed with mediastinum metastatic tumor. Gamma knife radiotherapy was used for management of mediastinal and supraclavicular lymph nodes. The patient died of system-ic metastasis one year later. Conclusion The vagus nerve and recurrent laryngeal nerve invaded by head and neck tumor or tho-racic tumor are the most common causes of the vocal fold paralysis in the aged. A careful history, detailed examinations, a care-ful analysis of imaging examination results of head, neck and chest and a close follow-up are necessary for finding the causes of the vocal fold paralysis in the aged, so that misdiagnosis and delayed treatment may be avoided.