Calcification of costal cartilage increases with age and it is rare before the age of thirty years. Early
onset of costochondral calcification can be associated several endocrine and metabolic diseases,
following a trauma, infections, malignancies or due to genetic factors and very rarely idiopathic. Our
case exemplifies premature calcification of costal cartilages. The patient was a 20-year-old lady,
referred to endocrine clinic in UMS polyclinic, Kingfisher, University Malaysia Sabah for evaluation
of metabolic and endocrine causes of premature costochondral calcification. Physical examination
findings were normal except mild tenderness over the left lower lateral part of the chest. Investigation
results were inconclusive to detect any underlying endocrine, metabolic or inflammatory conditions.
Chest X-Ray revealed bilateral calcification of the 10th, 11th and 12th costal cartilages and was diagnosed
as idiopathic calcification of costal cartilage. Only analgesics were given as treatment and the pain
subsided after few days.
Complete or partial restriction of the vocal cords usually occurs due to cancer, neurologic causes or mechanical causes like huge neck mass, trauma to the neck, viral infection, and sometimes iatrogenic during surgery. Bilateral vocal cord palsy is a severe condition that can lead to significant problems in breathing, speaking, and swallowing. If any patient presents with stridor, it requires urgent surgical airway management followed by specific treatment. A case of viral bilateral abductor vocal cord palsy in a 41-year-old female is reported here. The patient presented with stridor, and immediate tracheostomy was done. The stridor developed first 3 months earlier followed by cold and fever for a week. The stridor worsened gradually and leads to a state of commencing immediate tracheostomy. There was no history of trauma to the neck or any neck surgery. All basic laboratory blood test was within the normal limit. The laryngoscopic examination showed both vocal cords were immobile and almost median position with a small gap at the posterior commissure. Chest and neck plain X-ray along with computed tomography scan of neck was normal which ruled out the other causes of bilateral vocal cord palsy. The patient subsequently underwent successful left posterior cordectomy by laser, and decannulation of tracheostomy was done, known as Kashima operation.
Synovial Sarcoma is a rare malignancy. It presents in adolescents and young adults. It occurs in soft tissue
of extremities usually near to the large joints, heart, lung, mediastinum, head and neck. A 23-year-old
female presented with a big hard fixed swelling in right supraclavicular region for 15 years. X-Ray chest
posterior-anterior view presented Homogenous opacity in upper lobe of right lung. USG of neck showed
large heterogeneous lobulated almost avascular solid mass in right side of root of neck and anterior upper
mediastinum may be associated with Schwannoma/ paraganglioma/soft tissue sarcoma. Spindle cell
lesion was reported by FNAC. MRI showed large slightly lobulated mass along right side of root of neck
and right side of superior mediastinum. A large soft tissue density mass along right side of neck and
superior mediastinum was found in CT scan. Surgical excision was done successfully. Histopathological
examination revealed spindle cell tumor favoring synovial sarcoma in the neck tissue and metastatic
spindle cell tumor in the lung lesion.