In unilateral vocal cord paralysis, which statement is true?

• A. It is never associated with cardiac anomalies
• B. Radiographic evaluation is not helpful
• C. Unilateral vocal cord paralysis may be associated with cardiac atrial enlargement or anomalous great vessels detectable on imaging
• D. All cases require surgical intervention

Answer: (C)

Unilateral vocal cord paralysis happens when the recurrent laryngeal nerve is impaired. The left nerve takes a longer, more circuitous route, looping under the aortic arch before ascending in the mediastinum. That anatomy makes it particularly vulnerable to thoracic and cardiovascular pathology. Because of this relationship, UVCP can be a sign of underlying heart or great-vessel abnormalities, such as atrial enlargement or anomalous great vessels, which imaging can reveal. Chest radiographs or more detailed imaging (echocardiography, CT, or MRI) may uncover these conditions, guiding further evaluation and management.

So the statement that unilateral vocal cord paralysis may be associated with cardiac atrial enlargement or anomalous great vessels detectable on imaging is accurate. Radiographic evaluation can be helpful in identifying the underlying thoracic etiologies, and not all cases mandate immediate surgery—some may be managed conservatively or addressed once a thoracic abnormality is identified.