This diffuse submucosal bleeding, involves the whole surface of the right vocal cord. In this patient, the hemorrhage was caused traumatic endotracheal intubation.
Submucosal hemorrhage of the vocal cord is different from a hemorrhagic vocal cord nodule, in which the bleeding is caused by a ruptured capillary and is limited to the nodule.
Submucosal hemorrhage of the vocal cord is usually caused by an episode of voice abuse (screaming). In general, it affects one cord, but could be bilateral. Patients who are taking anticoagulants have a greater tendency to bleed submucosally if they overuse their voice or cough. Clinically, this condition is manifested by hoarseness and vocal fatigue.