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A 71-year-old woman with a medical history of schizophrenia and psoriasis came to our clinic for evaluation of 5 episodes of oral bleeding (about 10-50 mL each episode) that had occurred intermittently over the previous 3 days. Her medical and family histories were otherwise unremarkable. She complained of dysphagia, hoarseness, and right-sided hearing loss that had been present for approximately 1 week. Evaluation of the oral pharynx revealed a parapharyngeal bulge on the right side, with no signs of active bleeding. There were signs of eustachian tube dysfunction, including tympanic membrane retraction and a middle ear effusion on the right side. There were no cervical bruits or lymphadenopathy. Evaluation with flexible laryngoscopy demonstrated a right vocal cord paralysis. The findings of the rest of the examination were unremarkable.
Powitzky R, Garcia R, Taylor C. Radiology Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2008;134(5):555. doi:10.1001/archotol.134.5.555