Throat Mass

42 Throat Mass


Ronda E. Alexander, Nazaneen N. Grant, and Andrew Blitzer


The finding of a mass in the upper aerodigestive tract is often discovered as a part of an investigation of a symptomatic complaint. These may include dysphonia, aphonia, dysphagia, dyspnea, hemoptysis, and odynophagia. This symptom directs the physician’s investigation to the site of the lesion. A mass may be congenital, infectious, inflammatory, neoplastic, or traumatic in nature, and there may be some overlap. Also, any lesion can cause bleeding if it is sufficiently traumatized. Historical points to consider include symptom duration, the presence of exacerbating or ameliorating factors, tobacco exposure, as well as recent travel and occupational risks. We divide the differential diagnosis of “mass” into groups according to the primary associated symptom; obviously some masses will cause multiple symptoms.


image Primary Associated Symptom


Dysphagia


Dysphagia: To solids worse than liquids is indicative of a mass lesion within the upper digestive tract. The mass may be either intrinsic to the esophagus or an internal deformation caused by an external compression. Dysphagia may occur with or without odynophagia (painful swallowing).


image Intrinsic mass


image Foreign body granuloma: An irregularity overlying an ingested object; the mucosa may be intact or ulcerated.


image Actinomycosis: May be associated with immumocompromise, although not always.


image Epithelial malignancy (squamous cell carcinoma): May appear as an ulcerated elevation or as an irregularly elevated area of mucosa.


image Glandular malignancy (ie, adenocarcinoma): Usually in the distal portion of the esophagus and associated with chronic changes related to gastroesophageal reflux


image Sarcoma: Remember that striated muscle predominates in the proximal one third of the esophagus.


image Neurofibromatosis type I: Plexiform neurofibroma may cause mechanical obstruction but it may also progress to pseudochalasia and liquid dysphagia.


image Leiomyoma: A smooth, submucosal mass in the distal two thirds of the esophagus


image Amyloid deposit: A smooth submucosal mass


image Hemangioma: Although these usually present during childhood, they may remain silent depending on size.


image Lymphatic malformation: Either infiltrative or externally compressive


image External lesions impinging on the aerodigestive tract


image Thoracic and mediastinal lymphadenopathy: Multiple etiologies


— Infectious, bacterial, or mycobacterial


— Neoplastic, usually from pulmonary primary neoplasm


— Autoimmune processes, most; commonly sarcoidosis


image Thoracic vascular anomalies: Anomalous arterial or venous origin, aortic anomalies, aneurysms


image Paraganglioma: Carotid body tumor, glomus vagale


image Thyroid and parathyroid neoplasia: Benign or malignant


image Ectopic thyroid: Often described in the tongue base, the mass effect of this tissue may impair lingual mobility and the passage of food bolus from the oral cavity to the pharynx.


image Thyroglossal duct cyst and patent tract remnants: If high in the neck, these may compress/displace aspects of the pharynx.

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Jun 5, 2016 | Posted by in OTOLARYNGOLOGY | Comments Off on Throat Mass

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