A 50-year-old woman presented with a bulge on the lower part of the right side of the neck that increased in size with exertion, coughing, or strenuous activity. She noted a pulling sensation from the right lower neck area down to her chest, intermittent hoarseness, and occasional shortness of breath. She slept well and had no recent history of pneumonia or infection. She was otherwise healthy, did not smoke, and had a medical history significant only for hypercholesterolemia. Her physical examination was remarkable for a fullness and a bulge in the right lower neck area, which were induced with Valsalva maneuver. The findings of careful laryngoscopic examination of the upper airway and trachea were normal. A computed tomographic scan was obtained (Figure).
Shah RN, Parikh SL, Johns MM. Radiology Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2007;133(7):724. doi:10.1001/archotol.133.7.724