A radiologic review of hoarse voice from anatomic and neurologic perspectives

Abstract

The differential diagnosis for hoarseness is extensive and includes a multitude of etiologies that span a large geographic area from the brainstem to the mediastinum. Therefore, localizing a causative lesion can be extremely difficult for clinicians and radiologists alike. In this review, we will first discuss the normal anatomy of the larynx and its innervation via the vagus and recurrent laryngeal nerves. We will then proceed with a guided tour of the various infectious/inflammatory, neoplastic, congenital, and traumatic/iatrogenic causes of hoarseness subdivided by anatomic location (brainstem, skull base, carotid sheath, thyroid, larynx, and superior mediastinum). Along the way, we will discuss the various cross-sectional imaging modalities best suited to detect the often subtle signs of recurrent laryngeal nerve injury. With thorough knowledge of these entities, radiologists can impact patient care by suggesting the appropriate imaging test and tailoring their search patterns to detect the subtle findings of laryngeal dysfunction.

The role of imaging in the evaluation of hoarseness: A review

“…SCC is the most common (around 98%) type of cancer involving the larynx, and around 50–60% of cases involve the glottis 14,17,33 . Glottic carcinoma presents early with hoarseness, and these masses are very well seen on direct laryngoscopy (Figures 23 and 24).…”

“…This is responsible for most of the signs of VCP that we see on imaging, such as ipsilateral pyriform sinus dilatation, medial rotation, and thickening of the aryepiglottic fold and ipsilateral laryngeal ventricle dilatation (Figure 7). [17][18][19] The thyroarytenoid F I G U R E 1 2 A hypervascular enhancing mass in the left jugular foramen (arrow in A) shows feeding vessels on the MR angiogram (arrow in B). They are heterogeneously hyperintense on T2 and can show salt and pepper appearance due to hypervascularity, flow voids, and microhemorrhages.…”

“…18 VCP may lead to hoarseness, but up to 40% of the patients may be asymptomatic. [17][18][19][20] According to some studies, CT neck may not reveal…”

“…This is responsible for most of the signs of VCP that we see on imaging, such as ipsilateral pyriform sinus dilatation, medial rotation, and thickening of the aryepiglottic fold and ipsilateral laryngeal ventricle dilatation (Figure 7). 17–19 The thyroarytenoid muscle gets atrophic over time, leading to laryngeal ventricle dilatation. Ipsilateral dilatation of the pyriform sinus and ventricle, thinning of the TVC due to atrophy, and thickening and medialization of the aryepiglottic fold can also be easily appreciated on coronal images.…”

Vascular Causes of Dysphonia: A Case Series with Different Etiologies

“…4 Differential diagnosis of dysphonia comprehends many different etiologies and many causative agents (from neoplasms and inflammations to traumatic injuries) that can occur in a large anatomical space (from the encephalic trunk to the upper mediastinum). 5 An accurate anatomical study is very important, and it is fundamental to remember that vascular etiologies are responsible for some rare cases of dysphonia.…”