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Clinical Problem Solving: Radiology
November 2002

Radiology Quiz Case 1

Author Affiliations
 

R. NICKBRYANMDS. JAMESZINREICHMD

Arch Otolaryngol Head Neck Surg. 2002;128(11):1330. doi:10.1001/archotol.128.11.1330

A 66-YEAR-OLD MAN with a 25–pack-year smoking history was seen in 1994 for a complaint of progressive hoarseness over the preceding 10 years. Indirect laryngoscopy revealed the presence of a vocal cord polyp, which was removed with no complications. The patient reported that his hoarseness diminished greatly after this procedure, but then he noted its progressive return and sought medical attention after a period of 7 years. On presentation, he denied dysphagia, dyspnea, cough, sore throat, or weight loss. Physical examination revealed an absence of cervical lymphadenopathy, and a chest x-ray film showed no abnormalities. On laryngoscopy, the left true vocal fold was found to be medially displaced, with a cherry-red mass attached to its undersurface. Both true vocal folds were mobile, and the airway did not appear to be significantly compromised.

Computed tomographic imaging of the neck revealed a 5 × 5-mm enhancing soft tissue mass on the undersurface of the left true vocal fold in its anterior third. The overlying thyroid cartilages, the ventricle, and the false cords were all within normal limits (Figure 1). Normal-sized, normal-appearing lymph nodes were present in the normal lymph node–bearing regions.

A biopsy specimen of the mass, which is shown in Figure 2, showed a well-circumscribed submucosal nodule composed of dilated vascular channels (V) surrounded by smooth muscle walls (SM).

What is your diagnosis?

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