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Clinical Problem Solving: Radiology
April 2005

Radiology Quiz Case 2

Author Affiliations

South Infirmary Victoria Hospital, Cork, Ireland

 

R. NICKBRYANMDPATRICIA A.HUDGINSMD

Arch Otolaryngol Head Neck Surg. 2005;131(4):367. doi:10.1001/archotol.131.4.367

A previously healthy 38-year-old male smoker presented with a 2-day history of worsening odynophagia and dysphonia. On physical examination, he was pyrexial, had mild inspiratory stridor, and was unable to swallow his own saliva. Palpation of the neck demonstrated a tender 2 × 2-cm mass in his left anterior triangle. Transnasal flexible fiberoptic laryngoscopy showed an erythematous left supraglottic fullness bulging medially to the midline. Laboratory tests revealed an elevated white blood cell count with neutrophilia. Therapy with broad-spectrum antibiotics and corticosteroids was initiated, and the patient was transferred to the intensive care unit for airway observation. The following day, he was symptomatically improved and another laryngoscopic examination revealed a reduction in the degree of supraglottic edema; however, a residual prominent bulge extending from the left false cord to the aryepiglottic fold was still evident.

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