Left vocal cord paralysis associated with long-standing patent ductus arteriosus

Abstract

Left vocal cord paralysis in association with patent ductus arteriosus is unusual. We report a patient with long-standing patent ductus arteriosus (PDA) in whom CT studies obtained before and after paralysis developed showed an interval increase in size of the pulmonary trunk. The pathogenesis of left vocal cord paralysis in association with long-standing PDA is discussed.

fig 1.

76-year-old woman with long-standing PDA. A and B, Axial CT studies at age 74, obtained for dyspnea, before left vocal cord paralysis developed. The pulmonary trunk is not present at the level of the lower border of the aortic arch (A). At the level of the carina (B), the main pulmonary trunk (arrow) is larger than normal. C, Digital subtraction aortogram, lateral view, at age 75, shows flow into the pulmonary artery through the PDA (arrow). D and E, At age 76, endoscopic views of larynx during quiet respiration (D) and phonation (E) show a large glottic gap (arrow) due to bowing of the paralyzed left vocal cord. F and G, Axial CT scans at age 76, obtained after paralysis developed. At the level of the lower border of the aortic arch (F), the pulmonary trunk (arrow) is present in the same section in which it was not seen before (A). There are no other mediastinal lesions. At the level of the carina (G), an enlarged and upwardly displaced pulmonary trunk (arrow) is seen adjacent to the expected course of the left recurrent laryngeal nerve. aA indicates ascending aorta; dA, descending aorta; P, pulmonary trunk.