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Image challenge
Man with difficulty breathing
  1. Glenn McFadden1,
  2. Kathryn Thompson2,
  3. William Weber1
  1. 1 Section of Emergency Medicine, University of Chicago Division of Biological Sciences, Chicago, Illinois, USA
  2. 2 Pritzker School of Medicine, University of Chicago Division of Biological Sciences, Chicago, Illinois, USA
  1. Correspondence to Dr William Weber, Section of Emergency Medicine, University of Chicago Division of Biological Sciences, Chicago, IL 60637-5416, USA; wweber{at}medicine.bsd.uchicago.edu

https://doi.org/10.1136/emermed-2020-210650

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    Clinical introduction

    A 51-year-old man with hypertension presented to the ED in respiratory distress. He was tachypneic with a muffled voice and reported 2 hours of acutely worsening dyspnoea. He was afebrile and denied pharyngitis. His examination revealed clear lungs and no oedema of the lips, tongue or posterior oropharynx. On fiberoptic laryngoscopy, the patient gagged, briefly revealing a midline, grape-sized mass in the posterior oropharynx (figure 1). Laryngoscopy excluded epiglottic or glottic oedema (figure 2).

    Figure 1

    Oral examination.

    Figure 2

    Video laryngoscopy …

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    Footnotes

    • Contributors All authors contributed equally to the manuscript. GM wrote the case. KT wrote the explanation. WW edited the paper, obtained consent and images from the patient, and coordinated submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; internally peer reviewed.