# Clinical Conundrum: Unveiling a Unique Presentation of Hypopharyngeal Carcinoma

## TL;DR

A rare case of hypopharyngeal carcinoma presented with unusual symptoms like subcutaneous emphysema and vocal cord palsy, highlighting the need for careful diagnosis.

## Contribution

This case report highlights a unique and rare clinical presentation of hypopharyngeal carcinoma.

## Key findings

- The patient exhibited subcutaneous emphysema, vocal cord palsy, and pooling of saliva, which are uncommon in hypopharyngeal cancer.
- A CT scan confirmed a 2x3 cm neoplastic growth in the hypopharynx, leading to a diagnosis of squamous cell carcinoma.
- The case emphasizes the importance of considering hypopharyngeal cancer in patients with idiopathic subcutaneous emphysema.

## Abstract

Dysphagia is a common symptom encountered in clinical practice, typically associated with a wide range of etiologies, including structural abnormalities, inflammatory conditions, neoplasms, and neurological disorders. However, the combination of subcutaneous emphysema, vocal cord palsy, enlarged arytenoids, and pooling of saliva in a dysphagic patient represents a rare and intriguing presentation.

A 33-year-old female presented at a tertiary care hospital in Western India with hoarseness of voice, difficulty in swallowing, productive cough, and neck pain for two months with an abrupt increase in the severity of all symptoms in two days. A history of chewable tobacco use for six years was disclosed. Clinical evaluation revealed a thin build with platynychia and conjunctival pallor, dental staining, drooling of saliva, the presence of extensive subcutaneous emphysema on palpation of the neck, and absent laryngeal crepitus. Endoscopic evaluation was suggestive of right vocal cord palsy and enlarged, congested arytenoid cartilages, post-cricoid growth with pooling of saliva in bilateral pyriform fossae. A CT scan of the neck showed a 2x3 cm neoplastic growth in the hypopharynx, with subcutaneous emphysema and free air foci in the head and neck region, prompting an immediate tracheostomy and biopsy of the hypopharyngeal growth with Ryle’s tube insertion. Squamous cell carcinoma was confirmed on the biopsy report.

Due to its rarity, the possible underlying cause of idiopathic subcutaneous emphysema should be sought whenever encountered in clinical practice since these patients are potentially misdiagnosed. A high index of suspicion among clinicians, along with a consideration of the constellation of other symptoms and clinical features of a possible underlying hypopharyngeal cancer whenever encountering such patients is of key importance for prompting further investigations and treatment.