Left recurrent laryngeal nerve paralysis: an unusual presentation of histoplasmosis

Right Vocal Cord Paralysis Caused by Histoplasmosis: A Case Report

OBJECTIVES

Histoplasma capsulatum is a prevalent dimorphic fungus, reaching an exposure rate of 90% in endemic areas such as the Midwest and Central United States. We report an unusual presentation of dysphonia due to right vocal cord paralysis caused by mediastinal lymphadenopathy from histoplasmosis.

METHODS

A 73-year-old male presented to an otolaryngology clinic with 4 months of hoarseness. Flexible strobolaryngoscopy demonstrated right vocal cord paralysis in lateral position and a full length glottic gap. Computerized tomography (CT) scan showed enlargement of a right paratracheal node.

RESULTS

A lymph node biopsy was obtained and showed histoplasmosis. He was treated with a 3-month course of pozaconazole. He then received a vocal cord medialization injection 2 months after symptom onset, which produced favorable improvement of his symptoms at 8-month follow up.

CONCLUSIONS

One other case report in the literature has reported left vocal cord paralysis related to histoplasmosis. This first case of right vocal cord paralysis was extremely unusual and is not often included in the differential diagnosis of vocal cord paralysis.

Multicenter VATS experience with mediastinal tumors

BACKGROUND

The use of video-assisted thoracic surgery for diagnosis and treatment of mediastinal tumors in a multiinstitution patient population is not well understood.

METHODS

We studied 48 cases from Cancer and Leukemia Group B thoracic surgeons. Of 21 men and 27 women, aged 41 +/- 16 years, 22 patients were asymptomatic. In the others, 92% of tumor-related symptoms improved or resolved after treatment. Five tumors involved the anterior compartment, 19 the middle, and 24 the posterior compartment. Diagnoses were typical for each compartment but also included uncommon problems such as superior vena cava hemangioma and a histoplasmosis cyst causing hoarseness. Of the lesions, a biopsy of 12 was done without excision and the rest were excised completely. Fifteen were cystic and 10 were malignant (8 biopsy only). Maximal dimensions were 5.2 +/- 3.3 cm.

RESULTS

Operations were briefer for 24 posterior (93 +/- 41 min) than 5 anterior (195 +/- 46 min, p < 0.01) or 19 middle mediastinal tumors (170 +/- 78 min, p < 0.01). Although 96% had vital mediastinal relations, only six open conversions were performed because of bleeding (n = 3), large size, impaired exposure, or rib attachments, and no patient had morbidity beyond that expected for the thoracotomy. Postoperative stay was shorter for the nonconversion group (3.2 +/- 2.8 versus 5.5 +/- 2.1 days, p = 0.05), as was chest tube duration (1.7 +/- 1.4 days versus 3.2 +/- 1.9 days, p = 0.03). There were no postoperative deaths or major complications, but 7 patients had minor complications. During a mean of 20 months of surveillance (range, 1 to 52 months), one cyst recurred (asymptomatic) as did one sarcoma that was excised.

CONCLUSIONS

Video-assisted thoracic surgery is a safe technique for benign mediastinal tumors, typically those in the middle and posterior mediastinum.