Case of the Month, January 2017

Hoarse Voice

Submitted by Ronik Bhangoo, MD, and Thomas J. Learch, MD

History of Present Illness

A 66-year-old male presents with four weeks of mild hoarseness. He reports a recent upper respiratory infection with a cough which has since resolved and that he thinks is unrelated. He also states that he is exposed to dust on a daily basis due to his employment in the rug business. Additionally, he notes a 5-pound weight loss in the past four months. He denies shortness of breath, hemoptysis, nausea or  vomiting. A review of systems is otherwise negative.

Medical History

Patient’s medical history is significant for hypertension, chronic kidney disease, psoriatic arthritis, obstructive sleep apnea and prostate cancer status post remote prostate resection.

Physical Exam and Laboratory work

No abnormal findings were found on physical exam. Comprehensive metabolic panel was significant for a creatinine of 1.6 consistent with the patient’s known history of chronic kidney disease.

Imaging

CT Neck without contrast

Figure 1 

For a larger image, please click on Bhangoo1

At the level of the larynx, there is medialization of the left vocal cord with slight ipsilateral enlargement of the left piriform sinus concerning for underlying left vocal cord dysfunction.

Question 1. What is the next best imaging study?

a) MRI brain without contrast

b) CT chest without contrast

c) Esophagram with barium swallow

d) MRI abdomen/pelvis with contrast

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