John Smith is a very pleasant 59 year old male, former smoker, who presented in 2013 with hoarseness and reflux-like symptoms as well as ongoing weight loss. He underwent esophogeal surgery in June of that year where a left vocal cord paralysis was identified. He was referred to Dr. Moursi and a CT scan of the neck demonstrated a necrotic AP window mass as well as an additional mediastinal lymphadenopathy.