Clinical question: Patient hypoechoic, concern for cord paralysis. Signs and symptoms: Hypotonia. Enhanced CT of the soft tissues of the neck:Limited images of intracranial space demonstrated ring enhancing lesions in bifrontal lobes at the site of previously noted large parenchymal hemorrhages. There is complete resolution of head CT of blood product at this site since prior head CT from 10 -- 4 -- 10.Images through the skull base, cavernous sinuses, paranasal sinuses and bilateral petrous bones are within unremarkable.Examination demonstrates edematous changes of the left piriform sinus with partial effacement of sinus and subtle enhancement. There is also evidence of left vocal cord paralysis and thickening. There is no evidence of a mass. The above findings could be result of trauma and extended duration of intubation. There is evidence of a sclerotic changes of left aspect of thyroid cartilage with some irregularity. This finding could represent a healing fracture. Further evaluate an MRI of larynx is recommended. There is no evidence of compromise of the airway. The thyroid lobes are within normal size and density. Trachea is intact. No definitive abnormality of the cervical spine is noted. Limited images of the apices of the lungs and mediastinum are within normal limits.60 cc of Omnipaque 350 is administered.
Edematous changes of the left piriform sinus with asymmetrical enhancement of the mucosal compared to the left may represent inflammatory change. There is evidence of left vocal cord paralysis with soft tissue thickening of the vocal cord. Above changes could be result of long term intubation. The sclerotic changes of the left aspect of thyroid cartilage compared to the right may be an anatomical variation however possibility of a posttraumatic fracture and healing process cannot be ruled out. Follow-up with a dedicated MRI of larynx is recommended if patient's symptoms do not resolve.