Case of the Month, January 2017, Page 2

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

For larger images, please click on Bhangoo2  and Bhangoo3

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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

c) Three-phase CT abdomen/pelvis with contrast

d) No further imaging is required

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