Pathology of carotid triangle of the neck as one of the extra-respiratory causes of chronic cough (clinical case)

Abstract

One of the extra-respiratory causes of chronic hacking cough is a tumorous pathological process in the carotid triangle of the neck. A 41-year-old patient sought medical assistance for a hacking cough that worsened in the evening and had lasted for more than 8 weeks. After treatment prescribed by the primary care physician, the patient noticed a short­term improvement. However, shortly after discontinuing the therapy, the cough resumed and intensified. The patient was referred for a consultation with an otolaryngologist. During the examination, an elastic, condensed formation with somewhat limited mobility and a smooth surface measuring 2.5 × 3.0 cm was found in the area of the carotid triangle of the neck. Ultrasound examination of the soft tissues of the neck and ultrasound Dopplerography of the neck vessels were performed. An entity was detected that, based on all ultrasound characteristics, appears to be a carotid paraganglioma on both sides. The diagnostic conclusion was confirmed by the result of neck magnetic resonance imaging, which described carotid paragangliomas. After establishing the diagnosis of carotid chemodectoma in the neck, the patient was consulted by an oncologist and referred to a specialized department, where they underwent successful surgical treatment. Following the surgical intervention, the patient remained under the dispensary observation of an otolaryngologist and a vascular surgeon for the next 12 months. During this period, there were no complaints of cough recurrence. The cessation of the triggering factor in the afferent pathway of the neuroreflex arc of the cough reflex, achieved by removing the carotid paraganglioma, contributed to the disappearance of the cough — a symptom that had negatively impacted the patient's quality of life.The clinician should be highly vigilant if an initiated cough persists for several weeks or months and the patient demonstrates an excessively sensitive cough reflex. It is important to remember that chronic idiopathic cough can be a distinct clinical entity with an unidentified underlying pathology, and it can also contribute to the identification of a clinical pattern different from cough-associated diseases. In cases of persistent idiopathic cough that is unresponsive to treatment, the concept of distinct afferent pathways and an «anatomical diagnostic protocol» should be employed to determine the pathology and guide patient management.