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Neuroradiology Case of the Week

Case 314

Corey Sides, MD and P-L Westesson, MD, PhD, DDS

Clinical Presentation: The patient is a 70-year-old female presenting with neck pain following a motor vehicle accident.

Imaging Findings: Axial non-contrast CT image through the paraglottic space [Fig.1], demonstrates a thin-walled, small, air-filled out-pouching anterior to the left aryepiglottic fold. There is no significant mass effect, and no evidence of external component.
     Sagittal, multi-planar reformatted image [Fig. 2] also demonstrates an infrahyoid, anterior paraglottic, air-filled outpouching.

Diagnosis: Internal laryngocele

Discussion: Laryngoceles are defined as an outpouching of the laryngeal ventricle due to obstruction of the saccule. They can be filled with air (as in this case) or fluid-filled. Patients can be asymptomatic, present with hoarseness or palpable mass. They can become also infected, and are then termed pyolaryngocele. There are commonly seen in glass blowers, chronic coughers, and wind instrument players. In some cases laryngoceles can be due to an obstructing mass, i.e. squamous cell carcinoma of the larynx.
     There are three types of laryngoceles and are classified by location. The internal laryngocele is confined by the thyrohyoid membrane; the external laryngocele (rarest type) protrudes outside the thyrohyoid membrane, and the mixed laryngocele has components both inside and outside the thyrohyoid membrane (most common type).
     The differential diagnoses of cystic and air-filled masses in this location include: laryngocele, thyroglossal duct cyst, second branchial cleft cyst, hypopharyngeal diverticulum, and abscess.

References:

1. Grossman RI, Yousem DM. Neuroradiology: The Requisites. Philadelphia, Mosby, 2003, pp670.2.
2. Cure JK. Laryngocele. (last modification 10/17/2006). https://my.statdx.com/action/dx.do?method=loadDx&dxId=laryngocele&textSearchValue=Laryngocele