Baba et al. Journal of Medical Case Reports 2011, 5:25 http://www.jmedicalcasereports.com/content/5/1/25 Page 3 of 4 Figure 2 Follow-up CT results. (a) A suggestive space-occupying lesion in the right lateral pharyngeal wall at the level of the epiglottis, and (b) a suggestive circumferential space-occupying lesion in the mucosa and airway constriction at the level of the thyroid cartilage. swallowing, allowing the patient to ingest solid foods. Moreover, the space-occupying lesion, which had been suspected as being tumor recurrence, had disappeared (Figure 3a,b). After CT evaluation, the tracheostomy was successfully reversed. Two years after primary treatment with radiation, no evidence has been found of tumor recurrence. The patient’s speech and deglutition were preserved, and his voice quality was within normal limits. Discussion Radionecrosis is one of the late complications of radio- therapy. Although its incidence is approximately 1% [1,2], it is predicted to increase because of the increasing use of concomitant chemoradiotherapy. One possible mechanism of pathogenesis is vasculitis-induced narrow- ing and occlusion of the intravascular lumens [6]. Although radionecrosis usually occurs within the first year after radiotherapy [7], it may occur more than ten years later [8]. Treatment regimens for radionecrosis Figure 3 CT results after administration of steroids and antibiotics. These show the disappearance of space-occupying lesions initially suspected as tumor recurrence at the levels of the (a) epiglottis and (b) thyroid cartilage. include application of antibiotics and steroids, hyperba- ric oxygen therapy, and surgical intervention [9]. The clinical manifestations of radionecrosis, including hoarseness, difficulties with oral intake, pharyngeal pain, dyspnea, and skin fistula, are similar to those of tumor recurrence [10]. In addition, although radionecrosis is frequently accompanied by various CT findings, includ- ing swelling of the surrounding soft tissues, segmenta- tion or collapse of the thyroid cartilage, defluxion of the arytenoid cartilage, and abnormal gases in contact with the cartilage, all of these findings are regarded as non- specific [3,4]. Moreover, only about 50% of patients with radionecrosis present with these CT findings [11]. CT images of the neck of our patient revealed a suggestive space-occupying lesion in the right lateral pharyngeal wall at the level of the epiglottis and a suggestive cir- cumferential space-occupying lesion in the mucosa and airway constriction at the level of the thyroid cartilage. In detail, CT scans showed mixed masses of enhanced and non-enhanced lesions at both the epiglottis and thyroid cartilage levels, masses that could have been