Figure 30a. Large cell lung carcinoma in a 64-year-old man. (a) Pretherapy coronal fused FDG PET-CT image of the neck shows moderate hypermetabolism in the right vocal cord (arrow) with no activity in the left vocal cord (arrowhead). (b, c) Axial (b) and coronal (c) fused FDG PET-CT images of the chest show extension of the lung mass (white arrow) into the aortopulmonary window; this extension caused paralysis of the left vocal cord due to involvement of the left recurrent laryngeal nerve, thus explaining the asymmetric metabolism of the vocal cords. Also seen are encasement and marked narrowing of the left pulmonary artery (black arrows) by the mass, thus illustrating the detail seen with PET-CT. Arrowheads in c = aortic arch.