Side Effects of Stem Cell Transplant Mimicking Symptoms of Known Amyloidosis.

Introduction: AL amyloidosis can involve the gastrointestinal (GI) tract in a sporadic manner, affecting certain anatomical areas while sparing others. Case Presentation: Our patient with AL amyloidosis and confirmed colonic involvement was found to have new odynophagia, GI bleeding, and imaging findings that might suggest AL amyloidosis. However, negative pathology results from esophageal biopsies suggested the patient's new ulcerations were more likely a side effect of her autologous stem cell transplant (SCT) and chemotherapy meant to target amyloidosis, as opposed to an effect of amyloid infiltration itself. Conclusion: GI involvement of amyloidosis requires a high degree of clinical suspicion and should be considered in patients with systemic diseases affecting the kidney, heart, and GI tract; however, when satisfactory biopsies obtained from endoscopy results are negative, other causes should be considered.

The Thyrohyoid Syndrome: Promoting Awareness with a Case Report and Systematic Review of the Literature.

OBJECTIVE: Neck pain is commonly referred to an ENT specialist and can be caused by the little-known inflammatory condition of the lateral thyrohyoid ligament. The pathophysiology of this condition is believed to be inflammation subsequent to over-exertion or cervical trauma. Typically, patients present with chronic unilateral neck pain. Elicitation of localized tenderness over the axis of the lateral thyrohyoid ligament on palpation is a key finding for its diagnosis. We present an unusual case with an acute course and subcutaneous inflammation and discuss its management in an effort to raise awareness for this often-misdiagnosed syndrome. METHODS: A systematic literature research on PubMed was performed selecting patients with a definitive diagnosis of thyrohyoid syndrome or lateral thyrohyoid ligament syndrome. RESULTS: We collected 54 cases from three studies. This condition is an important differential diagnosis for acute or chronic antero-lateral or unilateral neck pain. CONCLUSION: No specific radiological findings are defined and a CT scan is therefore not necessary for its diagnosis, but ultrasound is a useful tool to primarily assess any neck lesion. Once the diagnosis is made, a local infiltration of steroids is the most sustainable treatment option and relapse prevention.

Ingested Australasian Snapper (Chrysophrys auratus) Bone Migration to C5 Vertebral Body.

Fishbone ingestion has been reported multiple times previously as a cause of oesophageal perforation. This is a surgical emergency that needs to be identified early to ensure immediate medical attention. This report presents the case of a 70-year-old patient with laryngeal perforation and the migration of a Chrysophrys auratus (Australasian snapper) fishbone to the C5 vertebral body. It is hypothesized that the fishbone migrated from the larynx to the visceral fascia and prevertebral fascia before lodging in between the intramuscular substance of the longus coli muscle. Multiple imaging modalities were used to identify and locate the foreign body, including flexible nasopharyngoscopy, esophagogastroduodenoscopy, and a computed tomography (CT) scan of the neck. The exploration of the neck was done by the ENT team and the orthopaedic spine team via the left anterior cervical approach at the level of the C5 and C6 vertebral bodies. The foreign body was identified (15 mm fishbone) at the left lateral of the C5 body, lodged between the intramuscular substance of the longus coli muscle, and was successfully removed.

Injury of the Hyoid Bone as a Rare Complication in Cervical Spine Rehabilitation: A Case Report.

Neck pain is a common reason for primary care visits, and its differential diagnosis should consider various conditions. The reported incidence of hyoid bone fractures is extremely low, accounting for only 0.002% of all fractures. The most common causes of hyoid bone fractures include strangulation attempts and motor vehicle accidents. We report a case of an uncommon complication of manual therapy of the cervical spine. A 76-year-old woman complained of neck pain that worsened during speaking and swallowing, originating from a neck physiotherapy session. The otolaryngological examination revealed tenderness on the right side of the neck. Flexible nasal endoscopy demonstrated a shallow right piriform recess and asymmetry of the arytenoid cartilages. Computer tomography scan of the neck showed an isolated fracture of the right greater horn (cornu major) of the hyoid bone. The treatment was nonsurgical, with the use of a Schantz collar and pain relief drugs. Reported symptoms of hyoid bone fractures include dysphagia, odynophagia, and neck pain. In most cases of hyoid fractures, conservative management suffices, involving rest, analgesic and anti-inflammatory treatment, and neck immobilization. Surgical treatment is often necessary in the cases of fractures accompanying other injuries.

Diagnostic and Therapeutic Approaches for a Diabetic Patient Presenting with Secondary Syphilis and Severe Odynophagia.

Syphilis, an infectious disease caused by the spirochete Treponema pallidum, represents a pervasive global epidemic. Secondary syphilis is typically marked by the emergence of highly contagious mucocutaneous manifestations, including non-pruritic rashes on the palms and soles of the feet, alopecia, mucous patches, and condyloma lata. Here, we report a rare case of a 30-year-old male with newly discovered type 2 diabetes mellitus who presented with severe odynophagia due to secondary syphilis, confirmed by both nontreponemal VDRL/RPR and treponemal TPHA tests. Following the administration of a single-dose intramuscular injection of benzathine penicillin G 2.4 million units, the symptoms gradually decreased, allowing the patient to regain his health.

Acute Calcific Tendinitis of the Longus Colli Muscle Masquerading as Acute Meningitis: A Case Report and Review of the Literature.

We present a case report of a young female who presented with acute neck pain, odynophagia, and fever. These symptoms were suggestive of possible differential diagnosis including meningitis and retropharyngeal abscess. Subsequent radiological investigations led to a diagnosis of acute calcific tendonitis of the longus colli muscle. Typical clinical presentations and radiological findings of this rare condition are discussed.

Manifestaciones otorrinolaringológicas en la viruela del mono / Otorhinolaryngological manifestations in monkeypox

Antecedentes y objetivo En la actual emergencia sanitaria declarada por la Organización Mundial de la Salud (OMS) por viruela del mono se han detallado pocos datos sobre las manifestaciones otorrinolaringológicas (ORL) de dicha enfermedad. El propósito del estudio pretende describir las características clínicas de las manifestaciones ORL de la viruela del mono. Material y métodos Análisis descriptivo de 11 pacientes consecutivos con odinodisfagia o lesiones de la cavidad oral derivados al área de urgencias de ORL de un hospital terciario con factores de riesgo epidemiológicos que pudieran sugerir infección por viruela del mono. Se describen los hallazgos clínicos, diagnósticos y de tratamiento. Resultados El 90,9% de los pacientes habían tenido contacto sexual de riesgo previo. El cuadro de presentación predominante incluía fiebre de más de 38°C con odinodisfagia intensa. El examen físico mostraba úlceras y lesiones exudativas de presentación variable en la vía aerodigestiva superior. El frotis de las lesiones confirmó positividad en la reacción en cadena de la polimerasa (PCR) para viruela del mono en todos los pacientes. Conclusiones La infección por virus de viruela del mono puede presentarse en el área ORL con múltiples manifestaciones que precisan de un grado de sospecha epidemiológico alto y la confirmación con PCR para llegar a un diagnóstico de certeza. (AU)

Background and objective In the current health emergency declared by the World Health Organization (WHO) for monkeypox, few data on the otorhinolaryngological (ENT) manifestations of the disease have been detailed. The purpose of this study is to describe the clinical features of the ENT manifestations in monkeypox. Material and methods Descriptive analysis of 11 consecutive patients with odynodysphagia or oral cavity lesions referred to the ENT emergency department of a tertiary hospital with epidemiological risk factors suggestive of monkeypox infection. Clinical, diagnostic, and treatment findings are described. Results 90.9% of the patients had previous unsafe sexual contact. The predominant presenting features included fever over 38°C with severe odynodysphagia. Physical examination showed ulcers and exudative lesions of variable presentation in the upper respiratory tract. Smear of the lesions confirmed polymerase chain reaction (PCR) positivity for monkeypox in all patients. Conclusions Monkeypox virus infection can occur in the ENT area with multiple manifestations that require a high degree of epidemiological suspicion and confirmation with PCR to reach a diagnosis of certainty. (AU)

[Retropharyngeal calcific tendinitis-An underestimated cause of acute neck pain]. / Retropharyngeale Tendinitis ­ eine unterschätzte Ursache akuter Nackenschmerzen.

BACKGROUND: Retropharyngeal calcific tendinitis is an aseptic inflammation of the longus cervicis muscle. This rare acute pain disorder of the neck region is a prognostically benign condition compared to neurological or otorhinolaryngological differential diagnoses. OBJECTIVE: To capture the clinical appearance, diagnostics, treatment and course of this rare disease. MATERIAL AND METHODS: In this retrospective monocentric observational study, demographic, clinical, paraclinical as well as treatment and follow-up data of all inpatients with a diagnosis of retropharyngeal calcific tendinitis admitted to the Diako Hospital Mannheim in the years 2018 to 2021 were analyzed. RESULTS: This study included four female and one male patient with an age between 36 years and 77 years. Severe neck pain with restriction of cervical spine rotation was the leading clinical appearance, in four out of five patients there was a painful swallowing disorder. Inflammatory markers were elevated in four patients. Characteristic MRI or CT imaging alterations of the cervical spine confirmed the diagnosis. The symptoms resolved within 4-14 days after treatment with nonsteroidal anti-inflammatory drugs (NSAID) and four patients additionally received glucocorticoids. No recurrences were observed during the follow-up period of 5-30 months. CONCLUSION: The good prognosis of this rare disease is reflected by the rapid remission of symptoms under NSAIDs and glucocorticoids and by the absence of recurrences during follow-up. CT or MRI imaging is required to rule out differential diagnoses, and to confirm the characteristic imaging alterations of retropharyngeal calcific tendinitis. Additionally, cerebrospinal fluid puncture and otorhinolaryngological assessment may be necessary in some cases.

Need for frequent dilations after magnetic sphincter augmentation: an assessment of associated factors and outcomes.

BACKGROUND: Dysphagia is the most common complaint after magnetic sphincter augmentation (MSA), with nearly one-third of patients requiring at least one dilation following MSA. A subset of patients require frequent dilations, but there is a paucity of data on the characteristics of this population. This study aimed to identify predictors of the need for frequent dilations within the first year after implant and to assess these patients' outcomes. METHODS: This is a retrospective review of prospectively collected data of patients who underwent MSA over an 8-year period. Frequent dilations were defined as 2 or more dilations within 1 year of surgery. Patients completed baseline and 1-year postoperative GERD-HRQL questionnaires and objective physiology testing. Baseline demographic, clinical characteristics, and objective testing data were compared between patients who did and did not require frequent dilations. RESULTS: A total of 697 (62.7% female) patients underwent MSA, with 62 (8.9%) patients requiring frequent dilation. At a mean (SD) of 12.3 (3.4) months follow-up, the frequent dilation group had higher median GERD-HRQL total scores (21.0 vs. 5.0, p < 0.001), PPI use (20.8% vs.10.1%, p = 0.023), dissatisfaction (46.7% vs. 11.6%, p < 0.001), and device removal (25.8% vs. 2.2%, p < 0.001) rates. Acid normalization was comparable (p = 0.997). Independent predictors of frequent dilation included preoperative odynophagia (OR 2.85; p = 0.001), IRP > 15 mmHg (OR 2.88; p = 0.006), and > 30% incomplete bolus clearance (OR 1.94; p = 0.004). At a mean (SD) of 15.7 (10.7) months, 28 (45.1%) patients underwent device removal after frequent dilation. Independent predictors of device removal after frequent dilation within 5 years of surgery were preoperative odynophagia (OR 7.18; p = 0.042), LES resting pressure > 45 mmHg (OR 28.5; p = 0.005), and ≥ 10% failed swallows (OR 23.5; p < 0.001). CONCLUSIONS: The need for frequent dilations after MSA is a marker for poor symptom control, dissatisfaction, and device removal. Patients with preoperative odynophagia, high LES pressures, and poor esophageal motility should be counseled of their risk for these poor outcomes.

Large Zenker's Diverticulum: A Case Report.

Zenker's diverticulum (ZD) is a type of esophageal diverticulum, a relatively rare disease in the pharyngoesophageal area. It is a pulsion diverticulum, or false diverticulum, located dorsally at the wall between the pharynx and esophagus. This area is known as Killian's triangle or dehiscence and is a region of relative weakness. Common symptoms of ZD include dysphagia, choking, persistent cough, loss of weight, hoarseness, halitosis, regurgitation of undigested food, and borborygmi within the cervical region. We are reporting a case of oropharyngeal dysphagia due to a ZD in a 65-year-old man with a history of worsening dysphagia for two years. Clinical presentation, diagnosis, and treatment options for ZD are discussed, along with the underlying pathophysiology of this condition.

Otorhinolaryngological manifestations in monkeypox.

BACKGROUND AND OBJECTIVE: In the current health emergency declared by the World Health Organization (WHO) for monkeypox, few data on the otorhinolaryngological (ENT) manifestations of the disease have been detailed. The purpose of this study is to describe the clinical features of the ENT manifestations in monkeypox. MATERIALS AND METHODS: Descriptive analysis of 11 consecutive patients with odynodysphagia or oral cavity lesions referred to the ENT emergency department of a tertiary hospital with epidemiological risk factors suggestive of monkeypox infection. Clinical, diagnostic and treatment findings are described. RESULTS: 90.9% of the patients had previous unsafe sexual contact. The predominant presenting features included fever over 38 °C with severe odynodysphagia. Physical examination showed ulcers and exudative lesions of variable presentation in the upper respiratory tract. Smear of the lesions confirmed polymerase chain reaction (PCR) positivity for monkeypox in all patients. CONCLUSIONS: Monkeypox virus infection can occur in the ENT area with multiple manifestations that require a high degree of epidemiological suspicion and confirmation with PCR to reach a diagnosis of certainty.

Eosinophilic Esophagitis in the Setting of Prior Caustic Ingestion.

A seven-year-old male presented with complaints of food refusal, dysphagia, and odynophagia for three weeks. He also had a history of caustic ingestion six months prior to the presentation. Diagnostic esophagogastroduodenoscopy (EGD) revealed post-burn esophageal stricture, and biopsy confirmed eosinophilic esophagitis (EoE). In this report, we discuss the diagnosis and management of these pathologies. We suspect that the damage sustained from caustic ingestion laid the groundwork for the development of EoE in this patient.

Linfangioma hipofaríngeo en adulto: presentación de un caso clínico / Hypopharyngeal lymphangioma in adults: Presentation of a case report

Los linfangiomas son malformaciones linfáticas benignas infrecuentes; se manifiestan principalmente en la infancia. Pueden desarrollarse en cualquier zona del cuerpo, más frecuentemente cabeza y cuello, siendo su compromiso faríngeo extremadamente poco común. Dada su clínica inespecífica se requiere un análisis anatomopatológico preciso para concretar un correcto diagnóstico. Presentamos el caso de una mujer de 40 años con historia de disfagia y odinofagia de un año de evolución cuyo estudio imagenológico y con nasofibroscopía evidenció un tumor redondeado alojado en seno piriforme derecho, la biopsia excisional confirmó el diagnóstico de linfangioma. Se debe considerar el diagnóstico de linfangioma dentro de los diagnósticos diferenciales de tumores en faringe y concientizar su presencia en pacientes adulto, para ofrecer el manejo óptimo basado, ya sea en escisión quirúrgica completa, para evitar la recurrencia asociado, o al uso de sustancias esclerosantes.

Lymphangiomas are infrequent benign lymphatic malformations, with clinical manifestations mainly at birth or in childhood. They can develop in any area of the body, most frequently the head and neck, and their pharyngeal involvement is extremely rare. Given its nonspecific symptoms, it requires a precise pathological analysis to make a correct diagnosis. We present the case of a 40-year-old woman with a 1-year history of dysphagia and odynophagia whose imaging study and nasofibroscopy revealed a rounded tumor lodged in the right pyriform sinus. The excisional biopsy confirmed the diagnosis of lymphangioma. The diagnosis of lymphangioma should be considered within the differentials of tumors in the pharynx and awareness of its presence in adults to offer optimal management based on complete surgical excision to avoid recurrence or management with use of sclerosing substances.

[Otorhinolaryngological manifestations in monkeypox]. / Manifestaciones otorrinolaringológicas en la viruela del mono.

Background and objective: In the current health emergency declared by the World Health Organization (WHO) for monkeypox, few data on the otorhinolaryngological (ENT) manifestations of the disease have been detailed. The purpose of this study is to describe the clinical features of the ENT manifestations in monkeypox. Material and methods: Descriptive analysis of 11 consecutive patients with odynodysphagia or oral cavity lesions referred to the ENT emergency department of a tertiary hospital with epidemiological risk factors suggestive of monkeypox infection. Clinical, diagnostic, and treatment findings are described. Results: 90.9% of the patients had previous unsafe sexual contact. The predominant presenting features included fever over 38 °C with severe odynodysphagia. Physical examination showed ulcers and exudative lesions of variable presentation in the upper respiratory tract. Smear of the lesions confirmed polymerase chain reaction (PCR) positivity for monkeypox in all patients. Conclusions: Monkeypox virus infection can occur in the ENT area with multiple manifestations that require a high degree of epidemiological suspicion and confirmation with PCR to reach a diagnosis of certainty.

The critical role of computed tomography in the differential diagnosis of acute calcific tendinitis of longus colli muscle: A case report.

Acute longus colli calcific tendinitis (ALCT) is a non-infectious inflammatory process. The typical clinical triad is acute neck pain, neck stiffness, and odynophagia. These findings can be confused with many common pathologies. As ALCT treatment is conservative and relatively easy, making the correct diagnosis is important. Radiology is of critical importance in the diagnosis of ACLT. The detection of prevertebral calcification by computed tomography is pathognomonic. Herein, we present a case with a sudden onset of neck and occipital pain accompanied by odynophagia following acute trauma and diagnosed with ALCT by radiological examination.

Acute Calcific Tendinitis of the Longus Colli Muscles: An Entity That Should Be Known by Emergency Radiologists.

Acute calcific tendinitis of the longus colli muscle (LCM) also called acute calcific prevertebral tendinitis or retropharyngeal tendinitis is an inflammatory process of the LCM that results in acute and debilitating symptoms. Although the imaging appearances of this uncommon condition are specific, due to the rarity of this entity and lack of familiarity, it can be sometimes misdiagnosed as a retropharyngeal abscess. This case report presents characteristic radiological features of the acute calcific tendinitis of the LCM, which may be helpful for the emergency radiologist to accurately diagnose this condition to avoid unnecessary surgical interventions.

Effect of Single-Dose Preemptive Systemic Dexamethasone on Postoperative Dysphagia and Odynophagia Following Anterior Cervical Spine Surgery: A Double-Blinded, Prospective, Randomized Controlled Trial.

Background: The efficacy of preoperative dexamethasone in anterior cervical discectomy and fusion (ACDF) to reduce dysphagia and odynophagia remains controversial. This study evaluated the effect of a single dose of intravenous dexamethasone given as preemptive analgesia in the ACDF procedure. Methods: A total of 64 patients aged 18 years or over were randomized into two groups. The experimental group received dexamethasone 10 mg intravenously before surgery for 60 minutes, and the control group received normal saline. One surgeon operated on all patients. The Bazaz score and visual analog scale (VAS) for odynophagia were measured at 0 hour, 24 hours, 48 hours, 72 hours, and 2 weeks postoperatively. Prevertebral soft-tissue swelling (PSTS) and the modified Japanese orthopedic association (mJOA) score were measured preoperatively and 2 weeks postoperatively. Results: The Bazaz scores at 0, 24, 48, and 72 hours after operation were significantly lower in the dexamethasone group than in the placebo group (p < 0.001, p < 0.001, p < 0.001, and p = 0.004, respectively). The VAS scores of the dexamethasone group were significantly lower than those of the placebo group at 0, 24, 48, and 72 hours after surgery (all p < 0.001), but there was no significant reduction in the Bazaz score and VAS score at 2 weeks postoperatively. There was no difference in PSTS and mJOA preoperatively and 2 weeks postoperatively. Conclusions: A single dose of intravenous dexamethasone used preoperatively in single-level and multilevel ACDF can significantly improve symptoms of dysphagia and odynophagia early on postoperatively.

High risk and low prevalence diseases: Adult epiglottitis.

INTRODUCTION: Adult epiglottitis is a serious condition that carries with it a high rate of morbidity and even mortality due to airway occlusion. OBJECTIVE: This review highlights the pearls and pitfalls of epiglottitis in adult patients, including diagnosis, initial resuscitation, and management in the emergency department (ED) based on current evidence. DISCUSSION: Epiglottitis is a life-threatening emergency that occurs more commonly in adults in the current medical era with vaccinations. Children present more commonly with acute respiratory distress and fever, while adults present most commonly with severe dysphagia in a subacute manner. Other symptoms may include drooling, muffled voice, and dyspnea. Streptococcus and Staphylococcus bacteria are the most common etiologies, but others include viral, fungal, caustic, thermal injuries, and autoimmune. Lateral neck radiographs assist in diagnosis, but they may be falsely negative. Visualization of the epiglottis is the key to diagnosis. Airway assessment and management are paramount, which has transitioned from direct laryngoscopy to flexible intubating endoscopy and video laryngoscopy with assistance from anesthesia and/or otolaryngology if available. Along with airway assessment, antibiotics should be administered. Corticosteroids and nebulized epinephrine are controversial but should be considered. Patients should be admitted to the intensive care setting for close airway observation or ventilatory management if intubated. CONCLUSIONS: An understanding of epiglottitis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.

Foreign Body in the Cervical Oesophagus: A Case Report.

BACKGROUND: Foreign bodies in the upper aerodigestive tract represent an uncommon cause of visits to emergency departments. In the majority of cases, foreign bodies do not go beyond the pharynx. They cause dyspnoea or pneumonia if they reach the tracheobronchial tree. If ingested, they will pass spontaneously through the gastrointestinal canal in the majority of cases. Nevertheless, especially in the case of sharp-pointed or large objects, the foreign bodies can stop in the oesophagus. In case of dysphagia, stinging sensation and/or odynophagia occurring after eating a meal, a foreign body in the upper aerodigestive tract should be suspected. If not clinically visible, imaging is required. CASE PRESENTATION: A 72-year-old woman presented to the Emergency Department with pharyngodynia, odynophagia, stinging, dysphagia, and sialorrhea for 12 hours. Her symptoms started after eating a meal involving meat. The patient underwent a standard two-projection radiogram of the neck. The antero-posterior projection radiogram was unremarkable. The lateral projection radiogram showed 16 millimetres in maximum length radiopaque foreign body within the cervical oesophagus. The patient underwent transoral flexible oesophagoscopy under general anaesthesia, which resulted in successful removal of the foreign body (bony fragment). Her symptoms improved rapidly after the procedure, and the patient was discharged after 48 hours in good health. CONCLUSION: A foreign body in the cervical oesophagus may lead to visceral perforation. Once suspected, every effort should be made to identify and remove the foreign body to avoid potentially catastrophic consequences. In some cases, imaging could be necessary to detect the foreign body.