Isolated Hoarseness as the Initial Presentation of a Rare Primary Anterior Mediastinal Large‐Cell Neuroendocrine Carcinoma: Multimodal Ultrasound Features—A Case Report

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Primary large‐cell neuroendocrine carcinoma (LCNEC) of the anterior‐superior mediastinum is an exceedingly rare and aggressive malignancy. We report a case in a 38‐year‐old man who presented with isolated hoarseness as the only initial symptom, an uncommon clinical presentation that has rarely been reported in the literature. Multimodal ultrasound showed a hypoechoic mass with an inverted triangular morphology, markedly increased stiffness on elastography, and a “fast‐in and fast‐out” enhancement pattern on contrast‐enhanced ultrasound (CEUS). The patient received platinum‐based chemotherapy with concurrent thoracic radiotherapy followed by maintenance immunotherapy and remained alive with stable disease/partial response at the last follow‐up. This report is the first to define and summarize the tumor's multimodal ultrasound findings, aiming to improve early recognition of this rare entity and to provide a useful imaging clue for clinical practice.