Spot diagnosis case – WIN A PRIZE!
In every ELS newsletter, we share a clinical case for practicing your spot diagnosis skills. Send your answer to firstname.lastname@example.org and win a copy of the 2nd Edition Surgery of Larynx and Trachea by Marc Remacle and Hans Eckel! The prize will be awarded by a lottery between the competitors and the winner will be announced in the next ELS newsletter.
Please note that the current spot diagnosis case is now closed and a new one will be pubblished in the next ELS newsletter (February/March).
Spot diagnosis case 10 is now closed.
Scenario: A 61 year old male, with a background of recurrent sialoadenitis is an ex-smoker, and presents to the emergency ENT clinic with increasing shortness of breath during exercise over the past weeks, soft stridor and dysphagia to solid food. There is no weight loss, no history of reflux, and no pain. A flexible nasendoscopy is performed and shows the following image of the larynx. Both vocal cords have limited mobility. Multiple biopsies are done, and show a mixture of fibrosis and active inflammation. Bloods are done as well. A PET-CT scan shows a PET avid mass in the supraglottis.
1) What is your most likely diagnosis and differential diagnosis?
2) What blood tests would you order?
3) What treatment would you propose?
Spot diagnosis case 9 is now closed.
Scenario: This 56-year-old female with a history of COVID-19 pneumonitis and ICU admission visits the ENT outpatient clinic with a chronic cough and shortness of breath on exertion. Flexible laryngoscopy doesn’t show any abnormalities and there is normal vocal cord movement. There are some interesting findings on flexible tracheobronchoscopy.
1) What is the likely diagnosis? – Anwer: tracheobronchopathia osteochondroplastica.
2) What evidence of previous treatment do you see? – Answer: A-frame narrowing airway related to previous tracheostomy.
Spot diagnosis case 8 is now closed.
Scenario: This 65-year-old gentleman with a history of reflux disease presented with a sore throat, dysphonia and progressive shortness of breath over the past year. He’s a never smoker. CT showed a mixed density mass in the subglottis with ‘popcorn’ calcifications and there is no invasion to adjacent soft tissue or bone. Pathology shows granular calcifications in multinucleated chondrocytes.
- What is the likely diagnosis? – Answer: low grade chondrosarcoma
- What treatment would you recommend, and what are your considerations regarding treatment? – Answer: conservative if asymptomatic, endoscopic laser debulking if symptomatic, laryngectomy is reserved for large tumours in which surgery would cause destabilisation of the cricoid.
We welcome you to submit your cases for the spot diagnosis column*. If your case is chosen you will also win a copy of the book!
* Please make sure to follow rules and regulations regarding the submission of patient material in your own country.