[A rare cause of hoarseness]. / Een zeldzame oorzaak van heesheid.

BACKGROUND: Hoarseness caused by Ortner's syndrome is a rare diagnosis, first described in 1897 in a patient with an enlarged left atrium due to mitral valve stenosis. Due to mechanical compression on the left recurrent laryngeal nerve patients present with hoarseness. CASE DESCIPTION: A 70 year old male presents with hoarseness and an inability to swallow. Examination reveals a paresis of the left vocal cord. A Computed Tomography scan shows a saccular aneurysm of the proximal descending thoracic aorta, consistent with Ortner's syndrome. Patient was successfully treated with a thoracic endovascular aortic repair procedure. CONCLUSION: Hoarseness is rarely caused by cardiovascular conditions, a more common condition is a lung neoplasm. Thoracic aneurysms as a cause of Ortner's syndrome are often described in combination with a dissection of the aneurysm. Diagnostic work-up of persisting hoarseness without laryngeal pathology should include a contrast enhanced computed tomography (CT) scan to rule our life-threatening conditions.

Oral squamous cell carcinoma and a clinically negative neck: the value of follow-up.

BACKGROUND: In squamous cell carcinoma of the oral cavity (SCCOC), regular follow-up comprises 5 years of prescheduled visits, irrespective of tumor stage/classification and/or treatment. We analyzed our standard treatment and follow-up protocol in patients with a preoperative clinically negative neck (cN0) in SCCOC. METHODS: This is a retrospective chart analysis. Inventarization of treatment, occult metastatic spread, and follow-up were performed. RESULTS: In all, 197 patients were included. The occult metastatic rate was 24%. Eighty-three percent of recurrent disease presented within 2 years. Fifty-three percent of the patients with recurrent disease visited their physician outside prescheduled control visits. CONCLUSIONS: Ultrasound-guided fine-needle aspiration cytology currently is 1 of the most reliable staging techniques in cN0 SCCOC. Regular follow-up could perhaps be limited from 5 to 2 years of prescheduled follow-up visits.

FDG-PET in the clinically negative neck in oral squamous cell carcinoma.

OBJECTIVE: With improved diagnostic imaging techniques, it remains difficult to reduce occult metastatic disease in oral squamous cell carcinoma (SCC) to less than 20%. Therefore, supraomohyoid neck dissection (SOHND) still is a valuable staging procedure in these patients. METHODS: Patients with clinically and ultrasonographically staged cN0 SCC of the oral cavity underwent FDG-PET before SOHND. Histologic examination of neck dissection specimens was used as a "gold standard." RESULTS: Twenty-eight consecutive patients were included, representing 30 necks. Occult metastatic disease was found in 30% of SOHND specimens. Average diameter of metastatic deposits was 4.3 mm. Sensitivity, specificity, and accuracy of FDG-PET was 33%, 76%, and 63%, respectively. CONCLUSIONS: In patients with cN0 SCC of the oral cavity, FDG-PET does not contribute to the preoperative workup. FDG-PET does not replace SOHND as a staging procedure.

Optimised PET reconstruction of the head and neck area: improved diagnostic accuracy.

PURPOSE: Reconstruction parameters are an important factor in PET image quality. In the head and neck area, where the level of photon attenuation is relatively low, standard whole-body reconstruction (SWR) parameters may lead to suboptimal results. The purpose of this study was to evaluate the impact of optimised head and neck reconstruction (OHR) parameters on image quality and diagnostic accuracy, using pathology as the gold standard. METHODS: SWR parameters consisted of 2 iterations, 8 subsets and a 6-mm Gaussian filter. Predetermined OHR parameters were 4 iterations, 16 subsets and a 5-mm Gaussian filter, generating images with increased spatial and contrast resolution but also with increased noise. SWR- and OHR-based FDG-PET images of 28 patients with malignancies in the head and neck area were evaluated for primary tumour and pathological lymph nodes. Diagnostic accuracy was determined by histopathological verification after lymph node dissection. RESULTS: Using OHR, sensitivity for detection of a primary tumour increased from 92% to 100%. Eleven additional lymph nodes were visualised in eight patients, resulting in an increased sensitivity for lymph node metastases from 11% to 44%. Specificity decreased from 89% to 74% owing to visualisation of small reactive lymph nodes. In total, using OHR, FDG-PET diagnosis improved in six patients (21%) at the expense of three additional false positives for lymph node metastasis (11%). Primary tumour SUV(max) increased by 42%, indicating enhanced contrast resolution. CONCLUSION: Image reconstruction adapted to low photon attenuation in the head and neck area may improve image quality and the diagnostic value of FDG-PET, despite a slightly higher false positive rate attributable to the fact that visualisation of FDG accumulation in benign reactive lymph nodes is also enhanced.