Glottic squamous cell carcinoma causing acute upper airway obstruction

Case contributed by Maciej Debowski
Diagnosis certain


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

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 wk post completion of definitive radioRx. Increasing dysphagia odynophagia SOB.

Necrotic change in right piriform sinus tumor.  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 tumor with extensive edema.  Good clinical response to antibiotics.

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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