A Recurrent Problem

A CLINICAL PROBLEM-SOLVING article by Holenarasipur Vikram, from the Mayo Clinic, Phoenix, Arizona.
A 50-year-old woman from Texas had nasal stuffiness, postnasal drip, myalgias, cough, and hoarseness in early winter. She attributed her symptoms to “cedar fever,” a common environmental allergic reaction in Texas, which she had every winter for 3 to 6 weeks.
Six weeks later, her nonproductive cough and hoarseness persisted. She had no fever, chills, night sweats, pain, weight loss, nausea, vomiting, or rash.
Within the past 3 years, she had traveled to nearly every state in the contiguous United States as part of her marketing job and she had recently traveled to Arizona.
CT of the chest revealed a 10-mm spiculated nodule in the medial segment of the left upper lobe.
Flexible videolaryngoscopy which can be reviewed at NEJM.org revealed normal-appearing vocal cords without any lesions, atrophy, or inflammation. However, abduction and adduction of the left vocal cord was severely diminished, confirming paralysis.
On repeat CT of the chest 3 weeks later, the nodule in the left upper lobe had increased to 22 mm. A new 6-mm superior mediastinal lymph node and three new lung nodules were identified in the left apex, left lower lobe, and right lower lobe. [Original Article]

Notes

• abduction: 外転、拉致、アブダクション
• the contiguous United States: 地続きのアメリカ合衆国◆アラスカとハワイを除く48州で構成される、アメリカ本土を指す。