DEEPIKA KAMATH

Case presentation

Particulars

Thavarya Naik70 yrsMaleFarmerDavangere

Chief complaints

H/O difficulty in swallowing – 6monthsH/O food sticking in throat –

6monthsH/O swelling over left side of neck – 2 monthsH/O Change of voice – 1 week

History of presenting illness

Difficulty in swallowingInsidous, gradually progressive, Initially for

solids, since last week for liquids also.Associated with feeling of food being stuck in

throat on attempted swallowing.Burning sensation of throat on taking spicy

food items.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 swellingNo H/O discharge from the swelling.

Hoarsness

Insidious, gradually progressiveDull, muffled typeNo diurnal variationNo 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 monthH/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

breathingNo 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 BDInj Diclo 50mg BDInj PCT 500mg TID

Family history

No similar complaints in the family

Personal history

Appetite – DecreasedDiet – Mixed B&B – RegularSleep – AlteredHabits – 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 hgPR: 76/ MINRR: 18/ MINPallor, clubbing , lymphadenopathy – PresentIcterus, 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 – NormalMouth opening – adequateTeeth – Upper jaw edentilous, lower jaw lower

central incisors absent, rest are nicotine stainedBuccal mucosa, hard palate – Nicotine stainedRMT - NormalOropharynx – AP, Tonsil, PP, Base of tongue, PPW – NormalPalpation of base of tongue – Normal

INDIRECT LARYNGOSCOPY

Neck examination

Colour and appearance of skin – NormalLaryngeal framework – Inspection – normal, no widening, central, no

swelling.Palpation – No swelling appreciated.Laryngeal crepitus presentNo 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 normalParanasal sinuses: Non tender

PRE: NORMAL

PROVISIONAL DIAGNOSIS

Pyriform fossa malignancy extending to supraglottis