Elongated inflamed uvula mimicking early recurrence on planning CT in post-laryngectomy laryngeal squamous cell carcinoma: a diagnostic pitfall in adjuvant radiotherapy

Background: Laryngeal squamous cell carcinoma (SCC) requires rigorous post-operative imaging surveillance to detect early recurrence, yet benign post-surgical changes may mimic malignancy and create diagnostic uncertainty. Case Presentation: We report a case of a 65-year-old male with well-differentiated laryngeal SCC who developed a suspicious lesion in the oropharynx on planning CT for adjuvant radiotherapy, 2 months after total laryngectomy, raising concern for early local recurrence. Clinical Discussion: Further assessment using multiplanar MRI demonstrated a well-defined elongated uvula with homogeneous enhancement, slightly hyperintense on T2 and without diffusion restriction, consistent with postoperative inflammatory change. Comparison with pre-treatment imaging confirmed its benign nature, preventing unnecessary biopsy or PET-CT. Conclusion: This case highlights the importance of distinguishing benign anatomical variants from malignant recurrence during post-operative surveillance imaging in head and neck oncology.