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Wk 5, Case 1 - Review

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Patient History
T1 left true vocal cord carcinoma treated with definitive radiation therapy. Laryngeal pain.
Findings
Contrast-enhanced CT was performed from the skull base to the thoracic inlet. Patient has history of left T1 true vocal cord carcinoma treated with definitive radiation therapy. The study demonstrates diffuse enlargement of the bilateral aryepiglottic folds with the left being larger than the right. The attenuation within the aryepiglottic folds is relatively symmetric and relatively decreased attenuation indicating posttreatment edematous changes. No obvious evidence of aggressive masses is identified. The CT scan was obtained with breath holding which results in apposition of the true vocal cords which prevents detailed evaluation of the anterior and posterior commissures.

Bone windows show no evidence of cartilage erosion. No evidence of abnormal soft tissue air.

No evidence of enlarged lymph nodes are identified using standard size criteria.

The visualized portion of the lungs is grossly within normal limits, however, dedicated chest CT is necessary for complete diagnostic evaluation.

Visualization of the brain is grossly within normal limits. However, dedicated brain imaging is necessary for complete diagnostic evaluation.

Conclusions
1. Findings consistent with posttreatment changes following radiation therapy with asymmetry involving the left aryepiglottic fold likely due to higher dose delivery.
2. No evidence of enlarged lymph nodes using standard size criteria.

Case Discussion

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Suresh K Mukherji, MD, FACR, MBA

Clinical Professor, University of Illinois & Rutgers University. Faculty, Michigan State University. Director Head & Neck Radiology, ProScan Imaging

Tags

Neuroradiology

Head and Neck

CT

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