Figure 10.

Axial contrast-enhanced CT images. A patient treated 5 months earlier by irradiation for T3 supraglottic cancer, now presenting with progressive dysphagia. Laryngoscopy shows a fixed left vocal cord, suspect for tumour recurrence. (a) On a background of expected changes after radiation therapy, a centrally hypodense nodular area of soft tissue thickening is seen in the left ary-epiglottic fold (arrowheads). Furthermore, a large soft tissue defect (asterisk), connecting the left piriform sinus with the denuded thyroid cartilage lamina, is seen. The thyroid lamina appears slightly irregular, and is abutted by air. (b) At a lower level, soft tissue defects are seen to connect to the left piriform sinus, as well as to the laryngeal ventricle (asterisks). Note the fluid layer at the outer side of the thyroid cartilage (arrows). A FDG–PET study was strongly positive at the level of the supraglottis. Because of a rapidly deteriorating clinical situation, total laryngectomy was performed. Histologic examination revealed extensive tissue necrosis, but no laryngeal tumour recurrence.