Presentation
Long-standing dysphagia to liquid and solid foods.
Patient Data
There is an ill-defined, heterogeneous, soft tissue density mass lesion that is centered on the hypopharynx and infiltrating aryepiglottic folds, larynx, false and true vocal cords, arytenoid, thyroid and cricoid cartilages, thyroid gland (with thyromegaly and heterogeneous appearance), proximal trachea and esophagus (opposite to D2 level with dilated distal segment which contains air-fluid level) and pre-vertebral soft tissues. The mass lesion is abutting bilateral common carotid arteries without evidence of thrombus formation. Significant surrounding fat stranding is seen. The right internal jugular is slit-like (with luminal narrowing).
A few sub-centimeter lymph nodes are seen in level IV on the left side.
The nasopharynx is within normal limits. Suprahyoid structures including the oropharynx, oral cavity, parapharyngeal spaces, and retropharyngeal spaces are unremarkable. Both parotid and sub-mandibular glands appear unremarkable.
Nodular opacities are noted in right middle and lingular lobes which are most likely due to infective/inflammatory endobronchial disease spread.
A sub-centimeter peri-fissural nodule is seen in right lower lobe with most likely benign entity.
Slices through imaged brain parenchyma are with in normal limits.
Case Discussion
CT findings of hypo-pharyngeal malignant mass lesion with relation to the surrounding organs, dominant left cervical lymph nodes, and most likely acute infective/inflammatory changes in the lungs as described above
The patient did an endoscopic biopsy which revealed hypopharyngeal squamous cell carcinoma (T4bNxM0).
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