A 64-year-old man presented to the otolaryngology clinic with hoarseness of voice for 3 weeks associated with intermittent dry cough. He had no medical history or family history of cancer and was not a smoker. In the absence of other suggestive symptoms, as well as a normal physical examination that did not reveal any enlarged cervical lymph nodes or oropharyngeal or neck mass and an unremarkable nasoendoscopic examination, a diagnosis of laryngopharyngeal reflux was made. The patient was advised to try conservative management with dietary advice and proton pump inhibitors, and a clinical review was scheduled in 6 weeks. The patient only returned 3 months later when his hoarseness became worse. Repeat nasoendoscopy now showed left vocal cord palsy in the paramedian position. In the absence of a history of trauma and associated neurological or systemic symptoms, the main concern was an underlying tumor that impinged on the vagus nerve at various points or its recurrent branch. Results of a computed tomographic (CT) scan showed an ill-defined soft tissue mass, which was likely nodal disease, at the left supraclavicular (Figure 1), as well as the prevertebral and paravertebral region, which partially encased the left common carotid, left subclavian, and left vertebral arteries. This was along the expected course of the left recurrent laryngeal nerve and likely accounted for the left vocal cord palsy. However, the primary site of disease remained unclear. A fused positron emission tomography with CT (PET/CT) scan with fluorodeoxyglucose (FDG) tracer was then performed.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Ker-Kan Tan, PhD, MBBS, Division of Colorectal Surgery, Department of Surgery, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Level 8, Singapore, Singapore 119228 (firstname.lastname@example.org)
Published Online: February 10, 2022. doi:10.1001/jamaoto.2021.4280
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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