Pulmonary tuberculosis is prevalent in the Philippines with incidence of 554/100,000 people1, they usually present as chronic cough, hemoptysis, night sweats, afternoon fever and weight loss, but a patient presenting as hoarseness is rare and the tendency would be a delay in its diagnosis and management2-3.
A 41 year old male, who came in due to hoarseness of voice associated with occasional cough, no fever, no weight loss, chest x-ray showing homogenous haziness at the right lung apex, chest ct scan showed enlarged lymph nodes at the aorto-pulmonary window, a tuberculin skin test was done and was positive hence patient was started on anti tuberculosis treatment, after 3 months of treatment, patient noted only partial relief of hoarseness of voice. Repeat chest ct scan showed interval decrease in the size of non enhancing mass lesion with coarse calcifications at the aorto-pulmonary window due to conglomeration of enlarged lymph nodes, minimal fibrosis in the right apex and lingual. Bronchoscopy revealed paralysis of left vocal cords with no mass or any other lesions.
Aorto pulmonary window is a small space between the aortic arch and the pulmonary artery. A variety of structures traverse this window including left recurrent laryngeal nerve4. The enlargement of lymph nodes secondary from our patients' tuberculosis infection caused tuberculous lymphadenopathy which may compress the recurrent laryngeal nerve causing vocal cord paralysis, resulting to hoarseness.