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).
Razvi MA, Leo M, Sabat S. A Rare Cause of Oropharyngeal and Supraglottic Airway Narrowing. JAMA Otolaryngol Head Neck Surg. Published online March 22, 2018. doi:10.1001/jamaoto.2018.0009
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