Imaging for Throat Trauma with Pain and Hoarseness
CT with contrast of the neck is the recommended initial imaging modality for a patient with throat pain and hoarseness after blunt trauma (being elbowed in the throat). 1
Rationale for CT with Contrast
- CT angiography (CTA) is considered the first-line imaging evaluation for neck trauma, with high sensitivity (90-100%) and specificity (98.6-100%) for vascular injuries 1
- CTA simultaneously identifies extravascular soft-tissue and aerodigestive injuries with excellent sensitivity (100%) and specificity (93.5-97.5%) 1
- Laryngeal injuries that may cause hoarseness after blunt trauma require detailed evaluation of cartilage, soft tissues, and vascular structures
Clinical Significance
Hoarseness after throat trauma requires urgent evaluation due to potential serious underlying injuries:
- Laryngeal fracture
- Vocal cord hematoma or paralysis
- Recurrent laryngeal nerve injury
- Vascular injury
- Airway compromise
Imaging Algorithm
Initial imaging: CT with contrast of the neck
- Provides detailed evaluation of laryngeal cartilage, soft tissues, and vascular structures
- Can identify fractures, hematomas, and soft tissue injuries that may not be visible on plain radiographs
Secondary imaging options (if needed based on CT findings):
- MRI: For further evaluation of laryngeal cartilaginous injuries 1
- Direct laryngoscopy: For direct visualization of vocal cord function and mucosal injury
Why Not Other Modalities?
- Plain radiographs: Limited in evaluation of soft tissue injuries and may miss significant laryngeal trauma
- Ultrasound: Limited in neck trauma due to overlying soft tissue injury, cervical collar, or skin dressings 1
- MRI: Limited in initial trauma setting due to longer scanning time and potential critical nature of the patient's condition 1
Important Considerations
- Laryngoscopy should be performed before ordering imaging in cases of isolated hoarseness without trauma 1, 2
- However, in the setting of blunt trauma to the throat with hoarseness, imaging should precede laryngoscopy to rule out structural damage
- Airway assessment takes priority over imaging if there are signs of respiratory distress
Pitfalls to Avoid
- Delaying imaging in a patient with throat trauma and hoarseness
- Using plain radiographs alone, which may miss significant injuries
- Performing laryngoscopy before ruling out structural damage in trauma cases
- Failing to extend the CT scan to include the entire course of the recurrent laryngeal nerve when vocal cord paralysis is suspected
By following this approach, clinicians can promptly identify and manage potentially serious injuries following blunt trauma to the throat, reducing morbidity and mortality associated with delayed diagnosis.