Submucosal Bulge in the Hypopharynx Causing Dysphagia


A 54-year-old male presented to our clinic for consultation due to a new onset of dysphagia. The current symptoms of dysphagia had started 2 years prior to the visit and had been progressively getting worse. He also had severe pain and tightness in the left neck and occasionally had the sensation of choking resulting in the patient requiring a soft diet. The patient did not complain of any trouble with breathing. He had been medically treated for gastroesophageal reflux disease (GERD) in the past which was not successful in relieving his symptoms. A previous swallow study had been performed and the results showed no abnormalities. He also has a history of multiple surgeries and had previously been treated by multiple Otolaryngologists for extensive neck arteriovenous malformations (AVMs). The AVMs were located in the nasopharynx, left neck at levels II and III, as well as the sublingual, submandibular and parotid regions. His previous surgeries include a left neck dissection, mandibulotomy, parotidectomy and sclerotherapy for the treatment of the AVMs. His last surgery for the AVMs was 7 years prior to the patient’s presentation to our clinic. On physical exam, there was scarring from his previous surgeries on the left side of the neck as well as residual AVM on the left side of the neck. A transnasal flexible laryngoscopy exam was performed in our clinic which showed a bulge in the submucosa of the left supraglottic area and in the left nasopharynx. This supraglottic bulge extended towards the midline touching the epiglottis. The submucosal lesion also partially obstructed the left piriform sinus opening. The patient had several MRIs of the neck which showed residual AVM in the left nasopharynx and soft tissue density in the left supraglottic area. A computed tomography angiography (CTA) was ordered to for evaluation of the extension of the AVM towards the supraglottic area and piriform sinus opening, however, no AVM was identified in that area (Fig. 1).

DOI: 10.1007/s00455-014-9567-0

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Cite this paper

@article{Agarwal2014SubmucosalBI, title={Submucosal Bulge in the Hypopharynx Causing Dysphagia}, author={Jay Agarwal and Lisa T Galati and Carlos Di{\'o}genes Pinheiro-Neto}, journal={Dysphagia}, year={2014}, volume={29}, pages={629-631} }