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Clinical Problem Solving: Radiology
August 18, 2008

Radiology Quiz Case

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Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2008

Arch Otolaryngol Head Neck Surg. 2008;134(8):895. doi:10.1001/archotol.134.8.895

A 55-year-old woman presented with a 4-year history of effort-induced dyspnea. She had had hoarseness for many years and had undergone laryngoscopy 24 years earlier. She had experienced no occupational or personality-based vocal abuse. She also had no history of thyroid disease or neck trauma and no other symptoms, such as dysphagia or cervical pain. Her medical history was remarkable for type 2 diabetes mellitus and essential hypertension.

Physical examination revealed no dyspnea or stridor, and laryngoscopy showed normal mobility of both vocal cords; however, there was evidence of thickening of the anterior part of both true vocal cords, with narrowing of the anterior glottic inlet to 3 mm. The impression was of a subglottic mass or subglottic stenosis. Neck palpation revealed a mild enlargement of the thyroid gland. A computed tomographic scan (Figures 1, 2, and 3) demonstrated a large thyroid nodule and a 1×3-cm mass containing calcification emerging from the thyroid gland, invading the larynx in the subglottic area and upper trachea, destroying the cricoid cartilage, and extending to both vocal cords. Both vocal cords showed a mass with calcification. There was no evidence of tracheal stenosis.

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