Presentation
Right sided throat pain, fullness. Pain radiating to right ear. Odynophagia but no dysphagia. No nodes or neck mass palpable. Right vocal cord palsy on endoscopy.
Patient Data
Enlarged 24 mm node in right level, with loss of normal hilar architecture and with heterogeneous cortical echotexture.
Further mass at right parotid tail with similar US characteristics (13 mm).
No contralateral nodes visible on US.
18 G core biopsy of the right level 4 node performed.
Multiple abnormal right supraclavicular fossa nodes, extending into the upper mediastinum. These displace the IJV anteriorly, without frank invasion. Solid mass along posterior margin of the right parotid gland.
Small but rounded and suspicious nodes in left level 4.
Adduction and loss of definition of the right vocal cord, with pyriform fossa ballooning, compatible with right vocal cord impairment.
Multiple small pulmonary nodules in both lung apices, with a 32 mm left lower lobe mass on the chest component of the CT. There were also suspicious bilateral adrenal nodules.
Case Discussion
Core biopsy results confirmed metastatic lung adenocarcinoma. Staging T2A M3 M1C.
This is an example of nodal disease resulting in a vocal cord palsy from compression of the recurrent laryngeal nerve.
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