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Clinical Challenge
March 22, 2018

A Rare Cause of Oropharyngeal and Supraglottic Airway Narrowing

Author Affiliations
  • 1Department of Radiology H066, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
  • 2Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
JAMA Otolaryngol Head Neck Surg. Published online March 22, 2018. doi:10.1001/jamaoto.2018.0009

A man in his 60s with a history of chronic obstructive pulmonary disease (COPD) and dyspnea presented with right lower quadrant abdominal pain. A noncontrast computed tomographic (CT) scan of the abdomen demonstrated splenomegaly, ascites, and a retroperitoneal mass posterior to the pancreatic head. Fine-needle aspiration from the retroperitoneal mass and ascitic fluid revealed no malignant cells. The patient subsequently developed a left-sided lateral chest wall hematoma, and, in retrospect, it was thought that the retroperitoneal mass was actually a hematoma because multiple follow-up studies demonstrated the mass steadily decreasing in size. Echocardiography showed right atrial and ventricular dilatation and increased thickness of the interventricular septum. Laboratory tests showed elevated results for serum-free λ light chain and proteinuria levels and altered liver function tests but a normal coagulation profile. Routine surveillance noncontrast CT imaging of the neck demonstrated a submucosal soft-tissue mass containing few punctate calcifications centered in the epiglottis with clinically significant narrowing of the oropharyngeal and supraglottic laryngeal airways by the enlarged epiglottis (Figure).

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