Sonographic Findings of the Neopharynx after Total Laryngectomy: Comparison with CT
Jeong Hoon Leea,
Jeong Eun Sohna,
Du Hwan Choea,
Byung Hee Leea,
Kie Hwan Kima and
Soo Yil China
a From the Department of Diagnostic Radiology, Korea Cancer Center Hospital, 215–4, Gongneung-dong, Nowon-gu, Seoul 139–706, Korea. Address reprint requests to Jeong Hoon Lee, MD.
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FIG 1. Normal neopharynx in a 64-year-old man who underwent total laryngectomy 5 years earlier.
A, Sonogram at mid-neck level shows the ovoid neopharynx (arrows) between the subcutaneous layer of the anterior part of the neck and the cervical spine.
B, Sonogram 3 to 4 cm caudal to the level of A shows five layers around the neopharynx with alternating echogenicity. S indicates cervical spine; T, thyroid gland.
C, Diagram of B. 1 indicates innermost layer of interface and superficial mucosa; 2, inner layer of deep mucosa; 3, middle layer of submucosa; 4, outer layer of pharyngeal constrictor muscles; 5, outermost layer of adventitia; T, thyroid gland. Shaded areas are hypoechoic.
D, Axial CT scan at the same level as B shows a three-layered, round neopharynx. The thin hypodense middle layer corresponds to the submucosa (arrow). T indicates thyroid gland.
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FIG 2. Radiation-induced changes in a 54-year-old man who underwent radiation therapy 9 months earlier.
A, Axial CT scan shows diffusely thickened neopharynx (black arrows), platysmal thickening (white arrows), reticulation of the subcutaneous fat (arrowhead), and exaggerated enhancement of the submandibular gland (G), all consistent with benign radiation changes.
B, Sonogram at level of tongue base shows globular-shaped neopharynx (arrows).
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FIG 3. Locally recurrent tumor in a 61-year-old man who underwent total laryngectomy 7 months earlier.
A, Sonogram at the level of the stoma shows poorly defined hypoechoic mass (arrows) on the right side of the neopharynx with obliteration of outermost layer.
B, CT scan shows a poorly defined, enhancing solid mass (arrows), which obliterates the fat plane between the mass and neopharynx. Recurrent squamous cell carcinoma was confirmed pathologically.
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FIG 4. Locally recurrent tumor in a 44-year-old man who underwent total laryngectomy 14 months earlier.
A, Sonogram shows a poorly defined hypoechoic mass (arrows) on the right side of the neopharynx, which obliterates the outer three layers of the neopharynx.
B, CT scan shows a less discrete isodense mass (arrow) on right side of the neopharynx. Recurrent squamous cell carcinoma was confirmed pathologically.
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FIG 5. False-positive CT finding in a 68-year-old man who underwent total laryngectomy 5 years earlier.
A, Axial CT scan shows a well-defined isodense mass abutting left side of neopharynx (arrow). Preservation of surrounding fat plane is notable.
B, On axial sonogram, the mass shows horseshoe-like folded neopharynx (arrow). There was no clinical evidence of recurrence. Note the even thickness of each of the neopharyngeal layers.
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