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Clinical Challenge
June 2016

A Recurrent, Slow-Growing Retropharyngeal Lesion

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia
  • 2Department of Radiology, Naval Medical Center Portsmouth, Portsmouth, Virginia
JAMA Otolaryngol Head Neck Surg. 2016;142(6):599-600. doi:10.1001/jamaoto.2016.0265

A woman in her 20s with a history of a benign retropharyngeal mass was followed with serial examinations and imaging after a debulking procedure performed 1 year prior. She reported return of her symptoms after 11 months to include mouth breathing, snoring, and nasal obstruction with hyponasality and eustachian tube dysfunction. She also began to experience transient upper extremity paraplegias. She required hospital admission with steroid and anti-inflammatory treatment for partial resolution of symptoms. On examination, she was noted to have abnormal asymmetry of the posterior nasopharyngeal wall by flexible fiber-optic laryngoscopy without any overlying mucosal changes. Magnetic resonance imaging revealed a complete recurrence and enlargement of the retropharyngeal mass with dimensions of 4.2 (anterior to posterior) × 6.3 (transverse) × 5.1 (craniocaudal) cm. The mass was heterogeneously hyperenhancing on T1-weighting and centered at the atlantoaxial joint causing erosion of the upper dens, anterior arch of C1, and the basion (Figure).

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