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Clinical Problem Solving: Radiology |

Radiology Quiz Case 2

Tzu-Ying Huang, MD; Chung-Han Hsin, MD; Po-Wen Cheng, MD; Tzung-Shiahn Sheen, MD
Arch Otolaryngol Head Neck Surg. 2009;135(6):613. doi:10.1001/archoto.2009.40-a.
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A 25-year-old man presented with a several-month history of a globus sensation in his throat and intermittent dysphagia. He had no complaints of shortness of breath, sore throat, cough, recent upper respiratory tract infection, trauma, or vigorous exercise. He also had no history of gastroesophageal reflux, foreign body aspiration, neoplastic disease, or tuberculosis infection. He was afebrile and appeared healthy.

Laryngoscopy revealed a cystlike mass with intact mucosa overlying the posterior pharyngeal wall, just posterior to the arytenoids (Figure 1). A barium esophagogram did not show esophageal extension of the mass. An axial T1-weighted postgadolinium magnetic resonance image (MRI) with fat saturation (Figure 2) and an axial T2-weighted fat-saturated MRI (Figure 3) of the neck were obtained. The lesion showed hypointensity and peripheral rim enhancement on T1-weighted MRIs and hyperintensity on T2-weighted MRIs. Three months of close examination of the lesion showed no regression. The patient underwent a complete and uneventful surgical resection via direct laryngoscopy under general anesthesia. Tissue sections were stained with hematoxylin-eosin for histopathologic analysis (Figure 4, original magnification ×100). The patient's symptoms resolved after surgery, and there was no evidence of recurrence at his 1-year follow-up visit.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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