Unilateral Vocal Cord Paralysis Diagnosed with Dynamic Digital Radiography

TL;DR

This paper presents a case where dynamic digital radiography (DDR) was used to diagnose unilateral vocal cord paralysis, offering a non-invasive and low-dose alternative to traditional methods.

Contribution

The study demonstrates DDR's feasibility for laryngeal motion analysis, a novel application of the technique.

Findings

DDR showed fixation of the left vocal cord in an adducted paramedian position during phonation.

CT confirmed the DDR findings without identifying additional anomalies.

DDR is proposed as a low-cost, low-dose, non-invasive tool for laryngeal functional assessment.

Abstract

Flexible laryngoscopy (FL) is the standard diagnostic tool for vocal cord paralysis (VCP), but it involves patient discomfort, and its interpretation is subjective and operator-dependent. Dynamic digital radiography (DDR) is a novel imaging technique that acquires high-resolution sequential radiographs at a low radiation dose. While DDR has been widely applied in chest and diaphragmatic imaging, its use for laryngeal motion analysis has been poorly investigated. We present the case of a 50-year-old male referred for Computed Tomography (CT) of the neck and chest for suspected vocal cord paralysis. The referring physician did not specify the side of the suspected paralysis. Due to a language barrier and the absence of prior documentation, a detailed history could not be obtained. To assess vocal cord motion, we performed, for the first time in our Institution, a DDR study of the neck. During phonation maneuvers, DDR demonstrated fixation of the left vocal cord in an adducted paramedian position. CT confirmed this finding and did not highlight any further anomaly. This case demonstrates the feasibility of DDR as a low-cost, low-dose, non-invasive technique for functional evaluation of the larynx and may represent a valuable complementary imaging tool in laryngeal functional assessment.

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