Introducción:  Caso clínico: Mujer de 77 años que ingresa con clínica de insuficiencia cardiaca y disfonía brusca. Las pruebas de imagen ponen de manifiesto un derrame pericárdico y la existencia de  severa cardiomegalia a expensas de aurícula izquierda aneurismática. Se realiza pericardiocentesis con mejoría del cuadro clínico de insuficiencia cardiaca si bien persiste disfonía residual al alta de la paciente. Discusión: El síndrome de Ortner o síndrome cardio vocal consiste en la parálisis del nervio laríngeo recurrente izquierdo originada por una afección cardiovascular, habitualmente y originariamente descrita por la dilatación auricular izquierda en relación con valvulopatía mitral reumática. El diagnóstico temprano puede ser útil para iniciar un tratamiento inmediato y restaurar la función de las cuerdas vocales. Conclusión: A la hora de valorar posibles causas de disfonía, es importante tomar en cuenta la etiología cardiaca ya que a pesar de que este síndrome tiene baja prevalencia, es importante tomarlo en cuenta ya que su tratamiento requiere un manejo multidisciplinario.

Background: Head and neck paragangliomas (HNPGLs) are rare neuroendocrine neoplasms that may be sporadic or hereditary and may occur as isolated, multifocal, or syndromic disease within the pheochromocytoma-paraganglioma spectrum. Synchronous bilateral carotid body tumors (CBTs) and bilateral vagal paragangliomas (VPGLs) are exceptional, particularly when biochemical activity and metastatic nodal involvement coexist. Case Presentation: We report a 33-year-old man with a 2-year history of enlarging bilateral neck masses, positive family history, and markedly elevated noradrenaline (6430 pg/mL; reference range <750 pg/mL). Initial CT angiography suggested bilateral CBTs, and Metaiodobenzylguanidine (MIBG) scintigraphy did not demonstrate abnormal adrenal or distant uptake. After alpha- and beta-blockade, staged surgery was performed. Right CBT excision demonstrated metastatic PGL, with two of four lymph nodes positive. Subsequent MRI and operative reassessment revealed synchronous bilateral CBTs and bilateral VPGLs. Left-sided surgery required partial debulking of a vagal-adherent mass to preserve nerve continuity; pathology confirmed PGL with Ki-67 index approximately 2% and left neck nodes were negative. Postoperatively, profound bradycardia required temporary then permanent pacing, together with bilateral vocal cord paralysis. During follow-up, swallowing and voice improved, the pacemaker was removed, and late imaging showed stable residual cervical disease without visceral metastasis on chest/abdominal CT. Conclusions: This case highlights the diagnostic and therapeutic complexity of multicentric, biochemically active HNPGLs and supports individualized multidisciplinary management, genetic counseling, biochemical surveillance, and long-term follow-up.

Aim: The aim of this study was to analyze anterior and posterior thickness measurements of the thyroid cartilage lamina and to assess their association with age and sex, with a focus on interindividual anatomical variability relevant to personalized medialization thyroplasty. Methods: A retrospective observational study was conducted on 47 patients with unilateral vocal cord paralysis who were candidates for medialization thyroplasty. The thickness of the thyroid cartilage was measured at its anterior and posterior aspects on an axial CT scan at the level of the glottic plane. The Wilcoxon signed-rank test was used to compare anterior and posterior thickness measurements, and a generalized linear mixed model (was fitted to assess the influence of anatomical region, age, and sex on cartilage thickness, with patient as a random effect. Results: The posterior thickness was significantly greater than the anterior thickness (median difference = 1 mm; p < 0.001). No significant differences were found in the magnitude of this difference by gender (p = 0.37) or a significant correlation with age (r = 0.16; p = 0.28). The mixed model confirmed that anatomical region was the only statistically significant fixed effect: the posterior region showed a Risk Ratio of 1.71 (95% CI: 1.26-2.32; p < 0.001) relative to the anterior region, indicating that the posterior thickness was approximately 71% greater than that of the anterior region. The interaction between cartilage thickness, age and gender was not statistically relevant. Discussion: In our sample, the thyroid cartilage had a thicker posterior width in both sexes. These findings underscore the importance of individualized radiological assessment in laryngeal framework surgery and support a personalized approach to implant selection and surgical planning in medialization thyroplasty.

Inspiratory stridor in neonates is typically attributable to laryngomalacia, vocal cord paralysis, or subglottic stenosis. Less commonly, vascular anomalies can cause inspiratory stridor.

Anaplastic thyroid carcinoma (ATC) is one of the most aggressive malignancies and is associated with an extremely poor prognosis. Multimodal therapy, combining surgery, radiation therapy, and chemotherapy, is recommended. Although paclitaxel and lenvatinib have been used as drug treatments, combination therapy with dabrafenib and trametinib has recently been reported to be effective. This combination therapy is generally associated with few serious adverse events, although rare cases of cardiac dysfunction have been reported. Here, we report the case of an 84-year-old woman with BRAF V600E mutation-positive ATC who developed cardiac dysfunction during combination therapy with dabrafenib and trametinib. The patient had no significant medical history and was referred to our department with left vocal cord paralysis and a thyroid mass. Histological examination of the right thyroid lobe tumor revealed components of undifferentiated carcinoma. Imaging studies showed invasion of the larynx and trachea, leading to total thyroidectomy, total laryngectomy, and paratracheal lymph node dissection. Postoperative pathological examination confirmed ATC (pT4aN0). Postoperative imaging revealed no distant metastases, and adjuvant radiotherapy was administered. Four months after the completion of radiotherapy, a cervical lymph node recurrence and right lung metastases were observed. As the tumor tested positive for BRAF V600E mutation using the MEBGEN™ BRAF kit, combination therapy with dabrafenib and trametinib was initiated. At week five of treatment, pitting edema developed in both lower limbs, and a decrease in the left ventricular ejection fraction (LVEF) was noted, prompting the discontinuation of therapy. By week six, the LVEF recovered, and dabrafenib was restarted at the same dose, whereas trametinib was resumed at a one-step reduced dose. Follow-up CT at week six demonstrated a partial response (PR). Treatment was continued at these doses; however, tumor enlargement was observed at week 26, leading to treatment discontinuation and a transition to palliative care. ATC remains extremely challenging to treat because of its rapid progression and low sensitivity to drug therapies. Furthermore, lenvatinib, a molecularly targeted agent, shows limited efficacy against ATC and is associated with frequent adverse events. In contrast, combination therapy with dabrafenib and trametinib is considered an effective therapeutic option for patients with BRAF V600E mutation-positive ATC, when appropriate management and monitoring are implemented.

Riedel's thyroiditis is an extremely rare fibrosing inflammatory disorder that extends beyond the thyroid capsule into surrounding structures. The disease usually progresses slowly; however, we report an unusual case with rapid progression that closely mimicked malignancy.An Asian woman in her 50s developed throat discomfort, hoarseness and a neck mass within 1 month. Laryngoscopy revealed left vocal cord paresis. Ultrasonography demonstrated a rapidly enlarging hypoechoic mass and fine-needle aspiration cytology suggested possible malignancy. Total thyroidectomy with lymph node dissection was, therefore, performed. Histopathological examination revealed dense fibrosis and obliterative phlebitis, consistent with Riedel's thyroiditis. The patient's hoarseness improved postoperatively, and she remains well 2.5 years later on levothyroxine monotherapy.This case illustrates that Riedel's thyroiditis can rarely present with acute progression and recurrent laryngeal nerve palsy, closely mimicking thyroid cancer. Early surgical intervention provided both a definitive diagnosis and effective treatment.