Laryngeal tumour - squamous cell carcinoma

Case contributed by Dr Derek Smith

Presentation

Acute presentation with stridor and difficulty breathing. Few months history of left sided neck swelling and a few days of haemoptysis. Heavy smoker and high alcohol intake.

Patient Data

Age: 50
Gender: Male
X-ray

Admission films

Main finding on admission films is of large soft-tissue swelling in the upper airway, consistent with the presentation of stridor and left-sided neck mass.

ENT performed a flexible nasoendoscopy in the ED revealing a large laryngeal mass obstructing the airway causing near complete occlusion.  Awake fibreoptic intubation was not successful and an emergency surgical tracheostomy was formed.

X-ray

Follow up films

Plain chest films following tracheostomy formation demonstrating left sided pneumothorax and surgical emphysema.  Tracheostomy and nasogastric tube in situ.

Annotated image

Annotated NG tip

Annotation of chest x-ray with altered windowing showing the position of the nasogastric tube tip - which should be slightly advanced.

CT

Staging CT

  • CT neck:
    • large laryngeal tumour with extralaryngeal spread and bilateral necrotic lymphadenopathy
  • CT thorax:
    • extensive surgical emphysema, pneumomediastinum and a left pneumothorax
    • left basal collapse and consolidation, minor right basal consolidation and small bilateral pleural effusions
    • multiple cervical and abdominal nodal and hepatic metastases consistent with stage IV disease

Case Discussion

This patient was an emergency presentation with near-complete airway obstruction from a laryngeal malignancy.  They required immediate surgical airway control before further imaging was performed which established widespread metastatic disease.

The case also illustrates some of the side-effects encountered with surgical intervention - the pneumothorax was managed conservatively.

Pathology of biopsies taken at the time of tracheostomy formation showed invasive squamous cell carcinoma.

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Case information

rID: 33257
Case created: 5th Jan 2015
Last edited: 29th Sep 2015
Systems: Chest, Head & Neck
Inclusion in quiz mode: Included

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