Differential Diagnosis for a 65-year-old Patient with Difficulty Breathing, Stridor, and Vocal Cord Paralysis after C-Spine Surgery
- Single most likely diagnosis:
- Bilateral vocal cord paralysis: This is a likely complication following neck surgery, especially after cervical spine surgery, due to the proximity of the recurrent laryngeal nerves to the surgical site. The patient's symptoms of difficulty breathing and stridor are consistent with this diagnosis.
- Other Likely diagnoses:
- Unilateral vocal cord paralysis with other airway obstruction: Although the patient presents with vocal cord paralysis, if it's unilateral, other causes of airway obstruction could exacerbate symptoms.
- Laryngospasm or laryngeal edema: Postoperative swelling or spasm in the larynx could cause stridor and breathing difficulties.
- Pulmonary complications (e.g., pneumonia, pulmonary embolism): These could be secondary to immobility and surgical risks, presenting with breathing difficulties.
- Do Not Miss diagnoses:
- Airway hematoma: A potentially life-threatening complication that could occur after neck surgery, causing airway obstruction.
- Tracheomalacia or tracheal stenosis: Although less common, these conditions could result from intubation during surgery or the surgical procedure itself, leading to breathing difficulties.
- Myasthenia gravis or other neuromuscular disorders: These could present with vocal cord paralysis among other symptoms and are critical to diagnose due to their significant impact on management.
- Rare diagnoses:
- Laryngeal or hypopharyngeal cancer: Although rare in this context, any new onset of vocal cord paralysis, especially if unilateral, warrants investigation for malignancy.
- Amyotrophic lateral sclerosis (ALS) or other motor neuron diseases: These could present with vocal cord paralysis but are less likely given the acute onset and recent surgery.
- Sarcoidosis or other granulomatous diseases affecting the larynx: These are rare causes of vocal cord paralysis and would be considered if other diagnoses are ruled out.