Dyspnea After Tracheostomy for Painful Cervical Swelling: What is Your Diagnosis?

A 60-year-old women was irradiated for oesophageal carcinoma one year ago. The patient has a cervical mass for 3 months, gradually increasing in volume, associated with high dysphagia and intermittent dysphonia. One month later, the symptoms were aggravated by the installation of an inspiratory dyspnea that became both inspiratory and expiratory. Physical examination finds a 10cm hard fixed and painful anterior cervical swelling ascending to swallowing, Nasofibroscopy finds a cordial diplegia in closure without individualization of tumor process. At the end of these symptoms, the patient had a cervico-thoracic CT scan. An emergency tracheostomy with surgical biopsy was performed in another hospital structure. The patient was lost to follow-up for two months, then she presented to the emergency room for dyspnea, hence the realization of a second cervico-thoracic CT scan (Figure 1,2).