Rheumatoid arthritis (RA) can affect any synovial joint including laryngeal joints. The disease is usually diagnosed clinically but the ‘gold standard’ for diagnosing laryngeal RA is laryngoscopy. The procedure is semi-invasive, requires a skilled operator, specialised equipment and is often not performed. In this case study, we demonstrate for the first time that fixed vocal cord narrowing in a patient with RA who presented with breathlessness and can be diagnosed by means of novel non-invasive methodology: dynamic 320-slice multi-detector CT (320-MDCT) larynx. CT studies revealed abnormal adduction and fixation of the vocal cords and supported a strong presumptive diagnosis of RA larynx in the absence of other causes. This advanced imaging modality may be valuable for simple, non-invasive evaluation of laryngeal function in RA, to monitor progression of disease and for follow-up of patients with RA larynx.