A Case for Careful Follow-Up S. J. is a 45-year-old gentleman who first presented for otolaryngological assessment for a left true vocal fold paralysis and associated dysphonia in June of 1997. The precise cause for the paralysis had not been determined. The patient's history included ulcerative colitis with a total colon resection and ileostomy ... Article
Article  |   May 01, 1998
A Case for Careful Follow-Up
Author Affiliations & Notes
  • Judith I. Kulpa
    Center for Communications and Swallowing, Division of Otolaryngology & Human Communication, Medical College of Wisconsin, Milwaukee
Article Information
Swallowing, Dysphagia & Feeding Disorders / Articles
Article   |   May 01, 1998
A Case for Careful Follow-Up
SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), May 1998, Vol. 7, 8-9. doi:10.1044/sasd7.1.8
SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), May 1998, Vol. 7, 8-9. doi:10.1044/sasd7.1.8
S. J. is a 45-year-old gentleman who first presented for otolaryngological assessment for a left true vocal fold paralysis and associated dysphonia in June of 1997. The precise cause for the paralysis had not been determined. The patient's history included ulcerative colitis with a total colon resection and ileostomy performed in 1995, as well as liver disease. At the time of the initial laryngeal assessment, S. J. reported only mild dysphagia. The patient had not been referred for a formal swallow study at that time. A chest x-ray of June 30, 1997 was normal.
The patient returned for routine follow-up in November 1997 with findings again showing a persistent left true vocal fold paralysis. A vocal fold medialization procedure was entertained for both voice and swallowing remediation. A pre-operative MRI scan of the left recurrent laryngeal nerve revealed lymphadenopathy both medial and lateral to the left scalene, muscle as well as extensive mediastinal lymphadenopathy. In addition, an ill-defined infiltrate-like density in the right mid lung field was noted. The differential diagnoses entertained were lymphoma, sarcoidosis, or primary bronchogenic malignancy. Mr. S. J. was referred to a cardiothoracic surgeon who performed a mediastinoscopy and biopsy. Pathology findings were nonspecific but compatible with possible sarcoid. Treatment with low dose steroids was initiated.
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