Paralisia das pregas vocais: como reconhecer, como fazer e o que procurar aos métodos de imagem?

Abstract

The exact incidence of vocal cord paralysis is unknown, but it seems to increase with age. The most common clinical findings include persistent hoarseness, dysphonia, and liquid aspiration. However, the presence of normal voice does not rule out the diagnosis and, in up to 35% of the cases, there are no symptoms. Therefore, this allows us to add the condition, side by side with adrenal, renal and thyroid nodules, for example, to the list of new incidentalomas that grow day by day in the routine of the radiologist. The “tsunami” of incidentalomas is principally due to the modern technological imaging arsenal available, with larger areas of the body being studied, in a faster and more accurate way, moreover with the advent of multidetector computed tomography (CT) scanners. The increase in detection of these “extra” findings, that elongate the radiologists’ observations at the end of their reports, implies the need of knowing the laryngeal anatomy and the typical radiological signs of vocal cord paralysis, even in asymptomatic patients. Enlargement of the piriform sinus, associated with thickening and anteromedial displacement of the ipsilateral aryepiglottic fold, are primary indicators of paralysis and can be easily recognized if little attention is dedicated to the region. The article in this issue of Radiologia Brasileira “Imaging evaluation of vocal cord paralysis” is valuable for its robust review of the vagus nerve and its branches. The main role of the radiologist dealing with a patient with known vocal cord paralysis is to detect or exclude innumerable and different lesions that may