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Clinical Challenge
July 2015

Laryngeal Swelling

Author Affiliations
  • 1Department of Radiology, University of Chicago, Chicago, Illinois
  • 2Division of Otolaryngology, Department of Surgery, University of Chicago, Chicago, Illinois
JAMA Otolaryngol Head Neck Surg. 2015;141(7):667-668. doi:10.1001/jamaoto.2015.0892

The patient was a woman in her 30s with a history of goiter, hypertension, asthma, obstructive sleep apnea, and skin lesions in the lower extremities for which biopsy findings more a decade before suggested sarcoidosis. She presented with a 1-day history of sore throat, fever, chills, productive cough, globus sensation, dysphagia, and a change in her voice to the point it had become muffled and hoarse. Throughout the day she noticed progressive worsening of her symptoms in addition to becoming dyspneic. The patient tried using her albuterol inhaler, but this provided no relief of her symptoms. The patient was afebrile at presentation, and there were no signs of infection. On examination, there was mildly tender right cervical lymphadenopathy but no evidence of peritonsillar exudates. Laryngoscopy demonstrated diffuse swelling of the supraglottic structures, particularly the epiglottis and left aryepiglottic fold, with a pale appearance of the mucosa (Figure, A). In addition, a neck computed tomographic (CT) scan was obtained, which showed marked swelling of the supraglottic structures with areas of patchy enhancement and narrowing of the airway, as well as enlarged right cervical lymph nodes (Figure, B-D). Owing to airway compromise, the patient was intubated and received intravenous steroids and ceftriaxone. Subsequently, she underwent debulking surgery and carbon dioxide laser ablation of the left arytenoid.

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