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Clinical Problem Solving: Radiology
February 2013

Radiology Quiz Case 2

JAMA Otolaryngol Head Neck Surg. 2013;139(2):189. doi:10.1001/jamaoto.2013.1287a

A 47-year-old man presented with T4aN2b squamous cell cancer of the left pyriform sinus (Figure 1 and Figure 2). He underwent a total laryngectomy, hemithyroidectomy, bilateral neck dissection, and supraclavicular artery island flap. The sternal heads of the sternocleidomastoid muscle were sewn to the prevertebral fascia to protect the great vessels. The patient did well after surgery, with good swallowing function and no evidence of recurrence. Before chemotherapy and radiation therapy were initiated, a routine computed tomographic scan of the neck with contrast was ordered as a screening study by his oncologist (Figure 3). The reading radiologist commented that there was a mass arising from the right external carotid artery that was “highly suspicious for a pseudoaneurysm.” The patient was urgently admitted to the hospital for further testing. A carotid angiogram was obtained (Figure 4).

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