DEEPIKA KAMATH

Case presentation

Particulars

Thavarya Naik

70 yrs

Male

Farmer

Davangere

Chief complaints

H/O difficulty in swallowing – 6months

H/O food sticking in throat – 6months

H/O swelling over left side of neck – 2 months

H/O Change of voice – 1 week

History of presenting illness

Difficulty in swallowing

Insidous, gradually progressive, Initially for solids,since last week for liquids also.

Associated with feeling of food being stuck in throaton attempted swallowing.

Burning sensation of throat on taking spicy fooditems.

Patient has increased salivation since last 1 week.

Swelling in left side of neck

Insidous, gradually progressive, initially size of pea when first noticed, which later progressed to present size of lemon.

No H/O sudden increase or decrease in swelling

No H/O pain over the swelling

No H/O discharge from the swelling.

Hoarsness

Insidious, gradually progressive

Dull, muffled type

No diurnal variation

No aggravating relieving factors

H/O cough since 6 months, associated with yellowish sputum, scanty, non foul smelling, non blood stained.

H/O recurrent fever present since last 6 months, associated with chills and rigors. More during evening time.

H/O loss of appetite since 1 month

H/O loss of weight since 1 month

No H/O regurgitation of food on lying down.

No H/O cough on swallowing liquids.

No H/O bad smell from mouth.

No H/O earache, ear fullness, decreased hearing, ear discharge.

No H/O Respiratory difficulty or noisy breathing

No H/O Haemoptysis, haematemesis, malena.

No H/O bone pains.

MEDICAL history

No H/O DM, HTN, TB, BA, Drug allergies, prolonged medication, Blood transfusions.

Treatment history

Patient has not shown to any other doctor for the present complaints.

Post admission patient has been put on symptomatic treatment.

Iv fluids (RL and DNS)

Inj Rantac 150mg BD

Inj Diclo 50mg BD

Inj PCT 500mg TID

Family history

No similar complaints in the family

Personal history

Appetite – Decreased

Diet – Mixed

B&B – Regular

Sleep – Altered

Habits – 1 pack bidi everyday since last 40 years (abstinence since 1 week)

Alcohol consumption (Brandy) around 250ml since 40 yrs. (abstinence since 1 week)

General examination

72 year old male patient, moderately built and poorly nourished

Conscious, co operative, well oriented to time, place , person

VITALS:

BP: 120/80 mm hg

PR: 76/ MIN

RR: 18/ MIN

Pallor, clubbing , lymphadenopathy – Present

Icterus, cyanosis - Absent

Systemic examination

CVS: S1 & S2 heard , no murmurs

RS: B/L NVBS heard, no added sounds

P/A: soft, non tender, no organomegaly

CNS: normal

Local examination

Oral Cavity

Lips, Angle or mouth, GLS, GBS, tongue, floor of mouth – Normal

Mouth opening – adequate

Teeth – Upper jaw edentilous, lower jaw lower central incisors absent, rest are nicotine stained

Buccal mucosa, hard palate – Nicotine stained

RMT - Normal

Oropharynx –

AP, Tonsil, PP, Base of tongue, PPW – Normal

Palpation of base of tongue – Normal

INDIRECT LARYNGOSCOPY

Neck examination

Colour and appearance of skin – Normal

Laryngeal framework –

Inspection – normal, no widening, central, no swelling.

Palpation – No swelling appreciated.

Laryngeal crepitus present

No tenderness

Lymph Node –

Inspection – Solitary smooth hemispherical Swelling of size 2.5x2.5 cm present above left middle third of SCM, margins well defined, no signs of inflammation seen. (Level III)

Palpation – Inspectory findings confirmed, no local rise of temperature, firm to hard in consistency, skin over swelling pinchable, mobile from side to side, immobile vertically.

EAR

RIGHT LEFT

Preauricular normal normal

Pinna normal normal

Postauricular normal normal

EAC normal normal

nose

Cold spatula test:

External appearance: normal

ARE Vestibule: normal Left sided DNS Turbinates pale Mucosa normal Paranasal sinuses: Non tender

PRE: NORMAL

PROVISIONAL DIAGNOSIS

Pyriform fossa malignancy extending to supraglottis