The n e w e ng l a n d j o u r na l of m e dic i n e

images in clinical medicine

Laryngopharyngeal Edema
A B C

A
fter undergoing sinus surgery a week earlier, a 77-year-old Kenta Watanabe, M.D., Ph.D.
woman presented to our outpatient clinic for nasal suctioning. Before under- Muneo Nakaya, M.D., Ph.D.
going the procedure, she received topical analgesia consisting of a mixture of Tokyo Metropolitan Tama Medical
a 4% lidocaine solution and a 1:5000 epinephrine solution. She had no history of drug Center
allergy and had received similar treatments in the past. Moments later, she reported Tokyo, Japan
nausea, hoarseness, and fullness in her throat. Fiberoptic laryngoscopy revealed quentaw@aol.com
marked mucosal edema of the arytenoid region (Panel A, black arrows), aryepiglottic
fold (arrowhead), and posterior wall of the pharynx (white arrows). One hour after
the administration of intravenous hydrocortisone, the laryngopharyngeal edema had
partially subsided (Panel B). The following day, she was asymptomatic, with evidence
of only minor edema of the left arytenoid mucosa. The edema had almost entirely
resolved at a 1-week follow-up visit (Panel C).
Copyright © 2011 Massachusetts Medical Society.

n engl j med 364;25 nejm.org june 23, 2011 e55

The New England Journal of Medicine
Downloaded from nejm.org on May 15, 2013. For personal use only. No other uses without permission.
Copyright © 2011 Massachusetts Medical Society. All rights reserved.