Glottic squamous cell carcinoma causing acute upper airway obstruction

Case contributed by Dr Maciej Debowski

Presentation

2 months sore throat. Biopsy proven SCC (p16 negative) of piriform fossa. T2N0M0. Underwent definitive radiotherapy.

Patient Data

Age: 70 years
Gender: Male

Staging FDG PET-CT

Modality: Nuclear medicine

Intense avidity in right piriform primary.  No nodal or distant mets. 

Incidental findings:  Asymmetry in right tonsil is likely inflammatory.  Reactive mediastinal nodes.  Diffuse skeletal uptake consistent with history of myeloproliferative disorder.

5 weeks post completion of definitive radiotherapy. Increasing dysphagia, odynophagia, SOB.

Modality: CT

Necrotic change in right piriform sinus tumour.  Likely combination of treatment effect with possibility of infectious process.  Severe narrowing of laryngeal airway.  No new lymphadenopathy.  Nasogastric tube in-situ.

The following day the patient developed stridor and required emergency surgical tracheostomy.  Operative findings: infected and necrotic tumour with extensive oedema.  Good clinical response to antibiotics.

1 month follow up CT

Modality: CT

Reduction in size of necrotic change and degree of mucosal enhancement in right piriform.  Marked improvement in airway narrowing.  New fistulous tract between right piriform sinus and trachea.

Case Discussion

Airway obstruction is a clinical diagnosis.  Presenting symptoms range from subtle dyspnea, cough, wheeze to stridor.  Patients are often able to maintain an adequate airway despite impressive radiological findings, however rapid deterioration is possible.

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Case Information

rID: 50541
Case created: 10th Jan 2017
Last edited: 22nd Jan 2017
Inclusion in quiz mode: Excluded

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