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Clinical Problem Solving: Radiology
August 2005

Radiology Quiz Case 3

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2005;131(8):740. doi:10.1001/archotol.131.8.740

A 62-year-old man presented with a 3-month history of progressive hoarseness and a 40-year history of tobacco chewing and frequent smoking (2-3 cigarettes per day). He had no history of alcohol use, voice abuse, dysphagia, pain in the throat, fever, weight loss, or hemoptysis. On mirror examination, he had an ulcerated lesion involving the laryngeal surface of the epiglottis and reaching up to the tip. The epiglottis was swollen, which prevented good visualization of the vocal cords. The neck examination did not reveal any adenopathy. The results of routine blood tests were normal, and a plain chest radiograph did not reveal any abnormalities. A computed tomographic (CT) scan revealed a mass in the supraglottis and anterior commissure (Figure 1 and Figure 2). On direct laryngoscopy, with the patient under anesthesia, a noduloulcerative lesion was observed in the epiglottis, starting from the tip and reaching up to the anterior commissure. The lingual surface of the epiglottis and vallecula also appeared indurated. A punch biopsy specimen was obtained from the ulcerated area and sent for histopathologic examination.

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