PMC3477763_01
56-year-old male with chronic thromboembolic pulmonary hypertension and sudden hoarseness. Appearance of the paralysed left vocal cord (white arrow) during fiberoptic laryngoscopy, no malignant lesion was detected in this examination.
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Fiberoptic laryngoscopy revealed left vocal cord palsy (Figure 1), while the rest of the otolaryngologic exam was normal.
Chest radiographs ((a) and (b)) from 2012 showed severe dilatation of both pulmonary arteries (arrows). (R = right pulmonary artery).
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Chest radiograph was relatively unchanged from previous studies obtained years ago and demonstrated massive dilatation of the pulmonary arteries, and tapering of peripheral pulmonary vessels (Figure 2).
Chest CT featured the signs of pulmonary arterial hypertension, pulmonary trunk (PT) dilatation, aneurysmal dilatation of the central pulmonary arteries (PA), wall-adherent thrombotic material in pulmonary arteries (asterix), right ventricular hypertrophy (white arrow in (d)). No mass lesion or lymphadenopathy was found and the radiologist suggested the cardiovocal syndrome as a possible diagnosis because of the obvious mass effect caused by the dilated central pulmonary arteries. The possible compression of the left recurrent laryngeal nerve between the aorta and pulmonary artery is well appreciated (black arrow in (a)).
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CT examination did not show a tumor. Chest CT showed the classical signs of pulmonary arterial hypertension, including extensive central pulmonary artery dilatation, wall-adherent thrombus in the pulmonary arteries, abrupt narrowing, or tapering of peripheral pulmonary vessels, right ventricular hypertrophy, right ventricular and atrial enlargement, dilated bronchial arteries, and a mosaic pattern of attenuation due to variable lung perfusion (Figure 3). The aneurysmal dilatation of the pulmonary arteries (Figures 3 and 4) is a known, but extremely rare finding in chronic thrombembolic pulmonary hypertension.
Coronal (a) and sagittal reformat (b) from the CT. The aortopulmonary window (arrow in (a)) is almost completely obstructed by the enlarged left pulmonary artery. (b) The sagittal reformat demonstrates the narrow space between the aorta (A) and pulmonary artery (PA).
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The aneurysmal dilatation of the pulmonary arteries (Figures 3 and 4) is a known, but extremely rare finding in chronic thrombembolic pulmonary hypertension.