RADIOLOGY QUIZ

A 28 year old female, case of thalassemia minor, diagnosed 2 years ago with adenocarcinoma of the colon, presented to the emergency room with progressive neck pain, sudden onset of dysphonia and mild dyspnea. Patient had history of hemicolectomy and had been started on chemotherapy (FOLFOX-5-FU and oxaliplatin) more than a year ago. She had reported upper extremity venous catheterization for the delivery of her chemotherapy. Patient was hemodynamicaly stable and had mild right neck swelling and tenderness anterior to the right sternocleidomastoid muscle, on perceptual evaluation she had a breathy voice. Flexible naso-pharyngo-laryngoscopy revealed a fixed right vocal fold in the paramedian position with incomplete closure during phonation. Computerized tomography of the neck and chest with intravenous contrast was ordered