Epiglottic masses identified on CT imaging: A case report and review of the broad differential diagnosis

Ectopic Thymic Tissue Presenting as an Epiglottic Mass Compromising a Neonatal Airway: A Case Report

An epiglottic mass (EM) is rarely found in neonates and poses life-threatening airway complications. We present the case of an infant urgently transferred from Belize via the World Pediatric Project with a lingual EM. The EM was misdiagnosed twice. The patient's home country of Belize initially misdiagnosed the EM as an elongated uvula and then again as an esophageal polyp. The true nature of the upper airway mass (UAM) was only discovered intraoperatively on rigid bronchoscopy as a lingual, mobile EM. Pathology of the lingual EM showed fibrovascular tissue with an area of exuberant capillary proliferation, cartilage, and ectopic thymic tissue. A second, smaller mass was also discovered in the left piriform sinus. The pathology revealed the presence of fibrovascular tissue, mucus glands, and a small amount of skeletal muscle. To the best of our knowledge, a thorough review of the literature reveals that this is the first description of ectopic thymic tissue presenting as an EM.

Evaluation of the Adequacy of Using the Supraglottic Airway Device (i-gel®) in Cases With Epiglottic Masses: A Mannequin Simulation Study

BACKGROUND

Epiglottic masses are often asymptomatic, making them difficult to detect during preoperative examinations. Consequently, anesthesiologists may face ventilation difficulties with no apparent cause. Epiglottic masses can sometimes obstruct laryngoscope insertion into the epiglottic vallecula, complicating general anesthesia induction. In such cases, supraglottic airway insertion may be a viable alternative; however, the limited case reports on its use for epiglottic masses make its applicability unclear. Therefore, we test the hypothesis that a larger laryngeal artificial mass could obstruct the view of the larynx, even when supraglottic airways are used in a mannequin study.

METHODS

We utilized an airway management simulator (Air Sim Multi®: Nihon 3B Scientific, Japan) to place various sizes of artificial masses (tumors) above the epiglottis. The groups included a control group with no mass, small size mass group, middle size mass group, and large size mass group. The supraglottic airway (i-gel®: Intersurgical, UK) was then inserted 10 times. We categorized the view of the vocal cords using a bronchoscope inserted through the tip of the cuff according to the Cormack-Lehane classification. In addition, we performed pressure-controlled ventilation, adjusting the inspiratory pressure from 10 cm H₂O to 25 cm H₂O, while measuring the tidal volumes.

RESULTS

The Cormack-Lehane classification grade increased in correlation with the mass size. In each inspiratory pressure, tidal volume decreased in correlation with the mass size. Furthermore, in the large-size mass group, even at an inspiratory pressure of 25 cm H₂O, achieving the tidal volume required for general adult respiratory management was deemed difficult.

CONCLUSION

In a mannequin study, we observed that epiglottic masses significantly increased the Cormack-Lehane classification grade and reduced tidal volume, with these effects correlating with the size of the mass. This finding suggests that the appropriateness of using a supraglottic airway may depend on the size and weight of the epiglottic mass.

Rhabdomyoma of the Oral Cavity Mimicking Reactive Lesions: A Case Report and Review of the Literature

Extracardiac rhabdomyoma is a tumor that rarely occurs in head and neck region. Adult and fetal types of extracardiac rhabdomyoma are diagnosed only by histopathological examination. In the oral cavity, this lesion usually affects the mouth floor and tongue. Despite the low incidence, adult rhabdomyoma should be considered in the differential diagnosis of oral cavity lesions, and histopathological evaluation might be helpful for the final diagnosis. This study aims to report a rare case of rhabdomyoma mimicking reactive lesions and review the literature. A 34-year-old male was referred to the pathology department with a yellowish sessile lesion in the labial maxillary vestibule. During an excisional biopsy, a mass of unencapsulated soft tissue beneath the vestibular mucosa was observed. The yellowish color in clinical features has led to lipoma as the initial clinical diagnosis. The histological examination exhibited an encapsulated, well-circumscribed benign neoplasm composed of multiple lobules of large polygonal cells with prominent abundant granular eosinophilic cytoplasm. No cellular atypia was observed. Diagnosis of the adult type of rhabdomyoma was made by collective agreement. Rhabdomyoma can be mistaken for other reactive lesions and may resemble their appearance.

Radiologic diagnosis of non-traumatic paediatric head and neck emergencies

Imaging plays a crucial role in evaluating paediatric patients with non-traumatic head and neck lesions in an emergency setting because clinical manifestations of these entities can overlap. For this reason, radiologists must be familiar with the clinical and imaging findings of prevalent paediatric head and neck emergencies. In this review, we present techniques and imaging clues for common complications of pathological processes in the paediatric head and neck, with a focus on the clinical scenario as a starting point for the radiologic approach.

Isolated Epiglottic Manifestations of HIV Infection: Two Cases Reports

Diagnosis of the Human Immunodeficiency Virus (HIV) remains challenging due to non-specific clinical presentations and mostly flu-like symptoms, e.g., fever, headache, sore throat, and general weakness. Oral lesions, such as oral candidiasis and Kaposi sarcoma, are also frequently associated with HIV infection, whereas laryngeal manifestations are rare. We report two cases of newly diagnosed HIV patients with clinical presentations of sore throat, and endoscopy revealed an epiglottic ulcerative tumor-like lesion. A laryngomicrosurgical biopsy of the lesions was performed for persistent symptoms and suspicion of malignancy. The result revealed acute and chronic inflammation without a conclusive pathology diagnosis. Further laboratory analysis was arranged in consideration of autoimmune diseases, Epstein-Barr virus (EBV), and HIV infection due to their persistent and atypical symptoms. The results were positive for HIV infection. These patients were treated successfully with antiviral treatment and the laryngeal symptoms improved within weeks. In patients with idiopathic and persistent epiglottitis or an epiglottic ulcer after medical treatment, HIV infection needs to be considered as a potential etiology in order to institute proper treatment.

Dual-time-point PET/CT study protocol can improve the larynx cancer diagnosis

Aim

To evaluate whether the sequential dual-time-point fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (DTP 18F-FDG PET/CT) study improves the differential diagnosis in the larynx.

Background

In some cases, the clinical and metabolic similarity of laryngitis and larynx cancer make differential diagnostics difficult when performing standard 18F-FDG PET/CT examinations; therefore, an additional study protocol performance seems to be of reasonable value.

Materials and methods

90 patients (mean age: 61 ± 11 years, range: 41-84 years): 23 women (mean age: 63 ± 10 years, range: 51-84 years) and 67 men (mean age: 61 ± 11 years, range: 41-80 years) underwent delayed 18F-FDG PET/CT examinations at 60 and 90 min post intravenous injection (p.i.) of the radiopharmaceutical 18F-FDG. We compared the metabolic activity of 90 structures divided into following groups: normal larynx (30 patients), laryngitis (30 lesions) and larynx cancer (30 tumors) with maximal and mean standardized uptake value (SUVmax, SUVmean) and the retention index (RI-SUVmax). We used the receiver operating characteristics (ROC) curve to evaluate the SUVmax cut-off values.

Results

The SUVmax cut-off value at 60 and 90 min p.i. of 2.3 (sensitivity/specificity: 96.4%/100%) and 2.4 (94.2%/100%), respectively, distinguished normal and abnormal metabolic activity in the larynx. When laryngitis and tumors were compared, the SUVmax cut-off values obtained after initial and delayed imaging were 3.6 (87.5%/52.0%) and 6.1 (58.3%/84%), respectively. The RI-SUVmax of 1.3% (71.4%/88.1%) suggested abnormality, while RI-SUVmax of 6.6%, malignant etiology (75.0%/80.0%).

Conclusions

In this study, the sequential DTP scanning protocol improved the sensitivity and specificity of the PET/CT method in terms of differential diagnosis within the larynx.

Mantle Cell Lymphoma: A Rare Vallecular Tumour

Vallecular lymphoma is an extremely rare tumour of oropharynx. We report a case of 61-year-old gentleman presented with severe dysphagia and globus sensation for two months. Patient underwent endoscopic transoral tumour debulking for diagnostic and therapeutic purpose. Histopathologically, patient was diagnosed as mantle cell lymphoma (MCL). In this case report, atypical presentation of the disease, histopathological features and its current treatments are discussed.

Emergency Imaging of the Nontraumatic Pediatric Head and Neck

Pediatric patients present emergently with a wide variety of infectious, inflammatory, congenital, traumatic, and neoplastic conditions. Imaging plays a crucial role in distinguishing among the potential diagnoses, as often, history and physical exam is limited in these young sick patients. Understanding the imaging appearance of the range of conditions which are commonly encountered and their potential complications, facilitates appropriate and expedient management. The radiologist must recognize the benefits of the various imaging modalities available and help the clinician choose among the possibilities depending on the clinical status of the patient.

Large Vallecular Masses; Differential Diagnosis and Imaging Features

Large vallecular masses are an uncommon disease entity which includes a wide spectrum of rare pathologies. These masses may present as purely vallecular in location or appear as an extension from adjacent anatomical sites like tongue base including lingual tonsils, epiglottis, palatine tonsils, epiglottis, and the remainder of supraglottis. Literature review reveals very rare conditions presenting as vallecular mass lesions. The imaging features are generally diagnostic for characterization. However, these masses can exhibit indeterminate appearance at imaging. We present a series of five cases which includes two rare presentations: a case of low-grade cribriform adenocarcinoma of the base of tongue and a vallecular lipoma. The other three cases presented for differential diagnosis including benign vallecular cysts and two cases to show that malignant masses arising from neighboring anatomical sites such as tongue base or supraglottic larynx can exhibit significant vallecular component.