縦隔血腫が原因と考えられた反回神経麻痺例

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Aim: Recurrent laryngeal nerve paralysis (RLNP) may occur for many reasons. We report transient RLNP apparently due to mediastinal hemorrhage and hematoma. We detail this case and review the literatures. Subject: A 69-year-old woman referred for sudden hoarseness and breathing difficulty had suffered a heavy coughing attack one night before symptoms appeared. Clinical examination showed right RLNP and diffuse brownish ecchymosis on the anterior chest. Upper mediastinal computed tomography showed a monotonous low-density area surrounding and compressing the trachea. FDG-PET showed no abnormality. Clinical course: Based on the clinical history and CT/MRI/FDG-PET, we suspected upper mediastinal hematoma. RLNP was assumed due to nerve compression by the hematoma. Paralysis decreased in one week and the hematoma disappeared in two months. Conclusion: RLNP due to upper mediastinal hematoma is rare, and differential diagnoses of malignant lymphoma and esophageal or lung cancer should be considered. Detailed clinical examination and CT/MRI/FDG-PET were useful in differential by diagnosing this case.