Clinical Review & Education Clinical Problem Solving | RADIOLOGY Oscar Trujillo, MD, MS; Justin Cohen, MD; Marc Cohen, MD; C. Douglas Phillips, MD A B C D Figure. Sagittal views of a patient with a neck mass. A, Computed tomographic scan of the neck with intravenous contrast. B, Magnetic resonance imaging examination demonstrating the mass compressed by the endotracheal catheter. C, Intraoperative image. D, Resection in a submucosal plane with scissors under microlaryngoscopy. Awomaninher50s with a history of hypertension and chronic back no respiratory distress. The primary team administered dexametha- pain presented to the emergency department. She had been discov- sonesodiumphosphateandconsultedtheotolaryngologyservice.On ered unresponsive in bed, was apneic, and was intubated in the field. examination, her vital signs were within normal limits, she was non- She had experienced multiple episodes of emesis. At presentation, a verbalbutinnoacutedistress,herbreathingunlaboredandsilent,with computed tomographic (CT) scan demonstrated diffuse subarach- no stridor or stertor. Passing a flexible fiber-optic laryngoscope con- noid hemorrhage, intraventricular hemorrhage, and communicating firmedthepresenceofanapparentsubmucosalmassthateitherorigi- hydrocephaluswithtonsillarandcentralherniation.Shereceivedman- nated from the epiglottis or deep to a severely edematous right ary- nitolandanemergentextraventriculardrain.Duringherhospitalstay, epiglottic (AE) fold or arytenoid, or completely obstructed the vocal a cerebral aneurysm was successfully treated by an endovascular cords from view. The mass did not
JAMA Otolaryngology - Head & Neck Surgery – American Medical Association
Published: Aug 1, 2014
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