Imaging is frequently carried out for the investigation of vocal cord palsy, and cord palsy needs to be considered as a sign of a more sinister underlying disease. The reporting radiologist needs to be aware of the relevant anatomy of the vagus and recurrent laryngeal nerves so that the responsible disease process can be identified. It is also important to recognize situations where a lesion at the level of the brainstem or skull base may be responsible, as a different imaging strategy often needs to be adopted in these cases. This review will also consider the laryngeal signs of cord palsy, as although cord palsy is often diagnosed clinically, up to 30% of cases may be asymptomatic and clinically unsuspected.
