A 32-year-old female is admitted to the emergency department with dyspnea, dysphagia, hoarseness, and severe anxiety. Her medical history reveals that she has lived on a liquid diet for some months and has lost more than 30 lb. Over the past several weeks, she has had bloody sputum during attacks of coughing. Fluoroscopy and a barium swallow reveal a 4-cm mass associated with a bronchus and associated compression of the esophagus. Which of the following nerves is most likely to be affected?
The left recurrent laryngeal nerve passes superiorly in the tracheoesophageal groove after looping around the aorta. The compression of this nerve and compression of the esophagus against the trachea would result in the presenting symptoms. The right recurrent laryngeal nerve loops around the right subclavian artery before passing toward the larynx and therefore does not descend into the thorax. The left vagus nerve courses posterior to the hilum of the lung, after it has already given off its left recurrent laryngeal branch at the level of the aortic arch; therefore, compression of this nerve would not result in the presenting symptoms. The greater thoracic splanchnic nerve arises from sympathetic chain ganglia at levels T5 to T9 and therefore would not cause the presenting symptoms. The phrenic nerve innervates the diaphragm; compression of this nerve would not result in the presenting symptoms.
Right recurrent laryngeal nerve
Left vagus nerve, posterior to the hilum of the lung
Left recurrent laryngeal nerve
Greater thoracic splanchnic nerve
Thorax