Answer: MRI brain and CT chest without contrast. The above findings are suggestive of unilateral vocal cord paralysis*. Evaluation of the course of the vagus nerve from the medulla to the ipsilateral recurrent laryngeal nerve should be undertaken. This patient’s MRI brain was normal.
*Of note, an outside laryngoscopy revealed left vocal cord paralysis prior to this CT.
CT Chest without contrast
Figures 2, 3
17 mm spiculated mass in the anterior segment left upper lobe consistent with a primary lung cancer. 18 x 11 mm enlarged lymph node or adjacent cluster of lymph nodes in the subaortic region of the mediastinum consistent with a stage IIIa lung cancer.
What is the next best imaging study?
a) Whole body PET/CT
b) MRI abdomen/pelvis without contrast
d) No further imaging is required
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