Fig. 20

Metastatic mediastinal lymphadenopathy. A 59-year-old woman with right breast cancer status post chemoradiation completed 5 years prior presents with rapidly progressive hoarseness. An axial non-contrast CT image (a) demonstrates anteromedial rotation of the left posterior vocal fold and arytenoid cartilage (white arrow) with associated left-sided dilatation of the laryngeal ventricle (white arrowhead). Associated PET image (b) demonstrates compensatory FDG uptake in the contralateral vocal fold (gray arrow). Contrast-enhanced CT (c) and PET (d) images more inferiorly reveal hypermetabolic prevascular lymphadenopathy in the superior mediastinum (black arrowheads). Overall, these findings are consistent with left vocal cord paralysis due to compression of the left recurrent laryngeal nerve by a metastatic prevascular lymph node