SHM Converge Scientific Abstract ePoster Gallery-Pain in the Neck

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A 79-year-old man presented with recurrent syncope, initially thought to be due to vasovagal episodes or dehydration from poor tube-feed adherence. He had a significant history of head and neck cancers, including tonsillar squamous cell carcinoma treated in 2005 and recurrent pyriform sinus squamous cell carcinoma treated in 2019 with total laryngopharyngectomy, tracheostomy, and PEG placement.<br /><br />On admission, orthostatic vital signs were positive, and he received multiple liters of intravenous fluids without improvement. He also reported right-sided jaw and neck pain that was out of proportion to exam. Despite aggressive fluid resuscitation, he continued to have repeated syncopal episodes.<br /><br />Imaging revealed the true cause: CT of the head and neck showed abnormal soft tissue swelling along the flap reconstruction, PET-CT demonstrated an FDG-avid lesion at the tongue base/right parapharyngeal region suspicious for tumor recurrence, and MRI of the neck showed a transfacial lymph node conglomerate involving the carotid sheath, including the right internal carotid artery and carotid bulb.<br /><br />He was diagnosed with carotid sinus syndrome caused by malignant compression of the carotid sinus/bulb from recurrent laryngeal cancer. Because surgery was not feasible due to carotid involvement and he poorly tolerated radiation sessions because of presyncope, he underwent an accelerated palliative radiation course (24 Gy in 3 weekly fractions). This led to significant clinical improvement.<br /><br />The case highlights that carotid sinus syndrome is a rare cause of syncope, accounting for about 1% of cases, and can result from direct compression by benign or malignant neck masses. In patients with recurrent unexplained syncope, especially those with a history of head and neck cancer and new local symptoms such as neck or jaw pain, clinicians should maintain a broad differential and consider tumor recurrence.

Asset Subtitle

Lara J. Sokoloff

Meta Tag

Author List Joshua A. Jones, Lara J. Sokoloff, Michelle Iocolano, Todd E. Hecht

Category Clinical Vignettes

Concept Carotid Sinus Syndrome

Concept Syncope

Concept Head and Neck Cancer

Concept Carotid Bulb

Concept Carotid Sinus

Distinguished Non-Finalist

Presenter Organization Hospital of the University of Pennsylvania

Presenting Author Lara J. Sokoloff

Track Adult

Keywords

syncope

carotid sinus syndrome

head and neck cancer

tumor recurrence

laryngeal cancer

carotid sheath

malignant compression

orthostatic hypotension

palliative radiation

neck mass

Carotid Sinus Syndrome

Syncope

Head and Neck Cancer

Carotid Bulb

Carotid Sinus