Baba et al. Journal of Medical Case Reports 2011, 5:25 http://www.jmedicalcasereports.com/content/5/1/25 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Unusual computed tomography findings of radionecrosis after chemoradiation of stage IV hypopharyngeal cancer: a case report Yuh Baba1,2,3*, Yasumasa Kato3, Kaoru Ogawa2 Abstract Introduction: Radionecrosis (post-radiotherapy laryngeal submucosal inflammation and necrosis) is a complication of (chemo) radiotherapy for hypopharyngeal cancer that is difficult to differentiate from tumor recurrence. Case presentation: A 67-year-old Japanese man presented with a condition extremely difficult to diagnose differentially as radionecrosis or tumor recurrence after radiotherapy for hypopharyngeal cancer. Although tumor recurrence was suspected from clinical conditions and computed tomography findings, pathologic analysis revealed no evidence of tumor recurrence, and successful therapy with steroids and antibiotics reduced the mucosal edema. Conclusion: Our findings emphasize the wide spectrum of radiographic presentation of radionecrosis after chemoradiation of stage IV hypopharyngeal cancer. Introduction Adverse reactions to radiotherapy can include both early and late complications. Late complications may arise more than several months after the completion of radio- therapy, even in patients who show no evidence of com- plications during exposure. These complications are generally irreversible, progress gradually, and cause cru- cial organ dysfunction. Late radiotherapy complications involving the head and neck area include disturbances of salivary secretion, jaw necrosis, chondronecrosis, hypothyroidism, subcutaneous tissue fibrosis, and devel- opment of second cancers. Improvements in radiother- apy seemed to have reduced the incidence of radiotherapy-related adverse reactions, from 5% during the 1970s to 1% during the 1990s [1,2]. Concomitant chemoradiation has become widely used in patients with advanced hypopharyngeal cancer, with an incidence of adverse reactions that has been predicted to increase in the future. To the best of our knowledge, however, few reports are available about computed tomography (CT) findings in patients with this condition [3,4]. We * Correspondence: yuh_baba@hotmail.com 1Department of Otorhinolaryngology, Ohtawara Red Cross Hospital, 2-7-3 Sumiyoshi-cho, Ohtawara City, Tochigi 324-8686, Japan Full list of author information is available at the end of the article describe here a patient who experienced radionecrosis (post-radiotherapy laryngeal submucosal inflammation and necrosis) after chemoradiation of stage IV hypo- pharyngeal cancer, focusing on CT findings. Case presentation A 67-year-old Japanese man visited our department complaining of pharyngeal pain. He had no appreciable medical or family histories, had smoked 30 cigarettes per day for 35 years, and had no drinking history. The patient had become aware of pharyngeal pain and had visited his general practitioner, but his condition did not improve. At his initial visit to our department, laryngopharyn- geal fiberoptic endoscopy revealed a neoplastic lesion in the left pyriform recess (Figure 1a). Vocal cord fixation was also observed. Pathologic examination of a biopsy specimen revealed a poorly differentiated squamous cell carcinoma (SCC), and contrast CT showed a tumor occupying the left pharyngeal cavity and infiltrating the thyroid cartilage (Figure 1b). Lymph node metastasis in the left side of the neck was confirmed, but no distant metastases were found. The patient was diagnosed with stage IVA hypopharyngeal cancer (T4aN2bM0) and received two cycles of docetaxel, cisplatin, and © 2011 Baba et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.