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Clinical Challenge
September 17, 2020

An Unusual Retropharyngeal Lesion

Author Affiliations
  • 1Indiana University School of Medicine, Indianapolis
  • 2Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
JAMA Otolaryngol Head Neck Surg. 2021;147(1):91-92. doi:10.1001/jamaoto.2020.2703

A female smoker in her 50s was referred for hyperparathyroidism and a multinodular goiter. The patient reported symptoms of joint and musculoskeletal pain and fatigue but denied fever, sore throat, abdominal pain, and kidney stones. Her medical history was remarkable for congestive heart failure and schizophrenia. Neck examination revealed no meaningful findings except right thyroid enlargement. Results of laboratory evaluation demonstrated normal white blood cell count, borderline hypercalcemia (10.6 mg/dL), and elevated parathyroid hormone level (208 pg/mL). She underwent ultrasonography at an outside facility, and results demonstrated a 2.2-cm dominant right thyroid nodule with additional smaller thyroid nodules. Findings of preoperative technetium-99m (Tc-99m) sestamibi planar and single-photon emission computed tomographic/computed tomographic (SPECT/CT) imaging (Figure, A) were nonlocalizing for a parathyroid adenoma and showed increased uptake in the dominant right thyroid nodule (Figure, B). Results of an ultrasound-guided biopsy of the thyroid nodule demonstrated a benign colloid nodule with cystic changes. Computed tomography with intravenous contrast was obtained, and findings were initially reported as negative except for right multinodular goiter. However, on additional review, a well-circumscribed fat density mass measuring 3.0 × 2.3 × 1.1-cm was identified in the right retropharyngeal space posterior to the hypopharynx (Figure, C).

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