Estella Bilson-Amoah*, Kenneth K Baidoo, Emmanuel D Kitcher F, Adam A Jangu and Kafui Searyoh
Ear, Nose and Throat (ENT) Unit, Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
*Corresponding Author: Estella Bilson-Amoah, Ear, Nose and Throat (ENT) Unit, Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana.
Received: March 24, 2022; Published: April 28, 2022
Fibrovascular polyp is a rare benign tumour of the hypopharynx and esophagus. It presents in a vague and non-specific way which can pose a diagnostic dilemma for many clinicians. Our objective in presenting this particular case is to introduce this extremely rare diagnosis and management of giant hypopharyngeal-esophageal fibrovascular polyp.
We present a 37-year-old man who was referred to the Ear, Nose and Throat (ENT) unit of Korle-Bu Teaching Hospital on account of a one-year history of foreign body sensation in the throat, dysphagia, discomfort in the throat and regurgitation of fleshy mass in the throat which leads to intermittent choking spells, asphyxiation and difficulty breathing. There was no cough, hemoptysis or weight loss.
He had been treated with several medications at several health facilities as pharyngitis and reflux disease with not much improvement until he was finally referred to our facility when symptoms of choking, asphyxiation and dyspnea were worsening.
On examination was a young healthy man with normal physical examination including ear, nose and throat. Flexible nasolaryngoscopy was revealed a suspicious lesion in the left vallecular- piriform fossa area but all other subsites were essentially normal. A computed tomography (CT) scan done was reported as a uvular mass which was inconsistent with our clinical suspicions. So, the CT films was interpreted by surgical team and revealed a polypoidal mass arising from the left piriform fossa and extending into the cervical esophagus. The other laboratory investigations done including FBC, sickling test, BUE Cr were essentially normal.
Diagnosis was made mainly based on clinical history and examination finding of the regurgitated fleshy mass in the throat as well as the CT scan films and suspicious flexible endoscopic findings.
The patient had an examination under anesthesia of his pharynx and esophagus using a rigid esophagoscope after which showed a huge polypoidal mass filling the left pyriform fossa and esophageal lumen. A lateral pharyngoscopy and excision of the hypopharyngeal polyp was done. Histopathology confirmed the diagnosis of angiolipoma.
Patient recovered fully on the ward and started normal diet after 10 days of nasogastric feeding. He is currently stable one month after surgery and is doing well almost one-month post operation.
When a young person presents with foreign body sensation in the throat with associated dysphagia, choking spells it should not be ignored and treated as reflux laryngitis, pharyngitis, or as psychogenic in nature especially when symptoms do not improve over a long period of time.
Our case emphases the need to take thorough history and take time to listen to patient for him or her to demonstrate all their symptoms and signs in order to make accurate diagnosis despite conflicting or uncertain findings on CT reports and endoscopy. It is also important to read the CT images ourselves as surgeons and to not only use reports which may contradict our clinical diagnosis or mislead us. It is important to read on any case that poses as a diagnostic challenge to point us in the right direction in our day to day case management.
Keywords: Hypopharynx; Giant; Polyp; Fibrovascular; Angiolipoma
Citation: Estella Bilson-Amoah., et al. “A Giant Hypopharyngeal - Oesophageal Fibrovascular Polyp".Acta Scientific Otolaryngology 4.5 (2022): 64-70.
Copyright: © 2022 Estella Bilson-Amoah., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.