Vocal cord bruise / hemorrhage (1 of 2)
Bruise, left vocal cord (right of image), estimated three weeks old, in combination with vocal nodules, capillary ectasia. There is likely an ectatic capillary also on the same side, within the nodule, that is the source of the leaking of blood into the tissues. When the bruise first occurred, it would have been most evident in the area of the nodule. As time passes, the central part of the bruise typically resolves first, with the last area to disappear anterior and posterior, as shown here. Note also the faint yellowish discoloration of the left cord, indicating residual hemosiderin (breakdown products of blood in tissue).

Vocal cord bruise / hemorrhage (2 of 2)
Same patient during phonation under standard light.

Vocal cord bruise / hemorrhage (1 of 6)
Breathing position, standard light. Notice a superficial bruise of the left cord (right of image), still very bright red. The source vessel cannot be identified with certainty here, but would be expected to be in the mid-cord, where the bruising is least evident. This is because mucosal oscillation tends to "massage" the bruise anteriorly and posteriorly, when the bruise is a thin-suffusion "wet pavement" type rather than a pocket or "puddle" of blood.

Vocal cord bruise / hemorrhage (2 of 6)
Prephonatory instant, standard light, shows that the margin of the left cord (right of image) is relatively straight. This suggests that the bruising is a very thin layer, and not a pocket of blood (as mentioned in photo 1).

Vocal cord bruise / hemorrhage (3 of 6)
Closer phonatory view, strobe light, also shows subtle elevation of the right cord (left of image), and a tiny ectatic capillary (small arrow), both of which can suggest that this person has been using the voice a lot. Left cord shows a darker linear bruise (larger arrow). After the bruising clears, perhaps it will become evident that this is in fact the ectatic capillary.

Vocal cord bruise / hemorrhage: after 2 weeks of rest (4 of 6)
After two weeks of relative voice rest, standard light. Notice the yellowish discoloration, which represents the breakdown products of hemoglobin. No obvious culprit capillary is seen. The last blood to resorb is always at the periphery from the point of origin.

Vocal cord bruise / hemorrhage: after 2 weeks of rest (5 of 6)
Strobe light, open phase of vibration. No obvious ectatic vessel is seen, except for the vessel on the non-bruised side (at arrow) that was seen in photo 3.

Vocal cord bruise / hemorrhage: after 2 weeks of rest (6 of 6)
Strobe light, closed phase, shows small margin swellings, greater on the left cord (right of image) than on the right cord. This swelling is being addressed by ongoing mild voice conservation, “on the fly” – i.e., while the person carries on with her work.

Bruise caused by violent coughing (1 of 2)
A person with violent sensory neuropathic coughing may injure the vocal cords, as illustrated by this bruise, right vocal cord (left of photo).

Closer view of bruise (2 of 2)
Closer view of bruise, with small collection of white mucus in the middle.

Bruising from SNC (1 of 1)
This individual occasionally coughs to the point of hoarseness. Particularly noteworthy is the subglottic bruise (arrow, dotted line) caused by profound Valsalva-retching kind of coughing. The rest of the right cord (left of photo) is also bruised.