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Clinical Problem Solving: Pathology
September 15, 2008

Pathology Quiz Case 2

Author Affiliations
 

JULIA C.IEZZONIMD

Arch Otolaryngol Head Neck Surg. 2008;134(9):1013. doi:10.1001/archotol.134.9.1013

A 45-year-old man presented with sleeping difficulty accompanied by an increase in snoring. His symptoms had gradually worsened so much over a 6-month period that he was unable to sleep on his back. He also noted that his voice had become deeper and that he had problems buttoning his shirt because of the girth of his neck. Physical examination revealed diffuse fullness of the lower neck area. His medical history was unremarkable. Endoscopic examination showed a large region of submucosal fullness along the posterior pharyngeal wall, continuing from the level of the superior hypopharynx and extending inferiorly. The degree of inferior extent could not be visualized endoscopically. Both vocal cords were intact and fully mobile. Magnetic resonance imaging (MRI) demonstrated a large prevertebral soft tissue mass extending from the level of C2-3 to T3 and measuring 15.4 cm in length and 3.9 × 8.4 cm in maximal anterior posterior and transverse dimensions, respectively. The signal intensity of the upper portion of the mass was predominantly low on T1-weighted images and predominantly high on T2-weighted images. The mass exhibited mixed areas of fat density on computed tomograms (Figure 1).

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