Behind the Voice: A CT-Based Clinical Review of Vocal Cord Paralysis and Its Diverse Etiologies

Vocal cord paralysis (VCP) is a radiologically significant finding that can indicate underlying pathology. This pictorial review outlines a computed tomography (CT)-based diagnostic pathway covering a range of VCP etiologies, emphasizing the critical role of thorough imaging interpretation. Although patients often present with hoarseness, CT imaging is essential in evaluating recurrent laryngeal nerve involvement. High-resolution contrast-enhanced CT, from the skull base to the aortopulmonary window, allows for a comprehensive assessment of the nerve's trajectory, aiding in the detection of neoplastic, inflammatory, or vascular causes. Pancoast tumor has been seldom reported as an unusual cause of VCP. In this article, we explore the anatomy of the recurrent laryngeal nerves and investigate various less common causes of vocal fold paralysis. By examining a series of CT cases from a tertiary care center, we highlight classical imaging features combined with structured diagnostic strategies for mediastinal evaluation.