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Haemoptysis, dysphagia, and odynophagia

BMJ 2008; 336 doi: (Published 01 March 2008) Cite this as: BMJ 2008;336:0803122
  1. Thomas King, final year medical student1,
  2. Giles Warner, consultant ear, nose, and throat surgeon1
  1. 1University of Nottingham Medical School
  2. 2Queen's Medical Centre, Nottingham

A 70 year old woman presented to the head and neck unit with a three month history of intermittent haemoptysis, progressive dysphagia, and odynophagia. On further questioning she reported no dysphonia or dyspnoea but complained of left sided otalgia. She had a 40 pack year history of smoking. Apart from controlled hypertension her medical history was unremarkable.

Physical examination showed a 3 cm lymph node in the anterior triangle of the neck but no other findings. Fibre optic laryngoscopy performed in the outpatient department showed a large epiglottic mass with normal vocal cords. She was admitted for examination under anaesthetic and imaging of the neck (fig 1).

Fig 1

Computed tomogram of the neck


  • (1) What is the likely diagnosis?

  • (2) What immediate management problem does this present?

  • (3) Why does the patient have earache?

  • (4) What does the definitive management entail?


  • (1) The computed tomogram shows a large lesion of the supraglottic larynx, involving the epiglottis and invading the left lateral pharyngeal wall. The photograph (fig 2) shows the view at direct laryngoscopy performed in theatre, showing an exophytic mass extending from the epiglottis to obscure the vocal cords. …

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