Clinical History
A 40-year-old female patient, who had been suffering from cough and hoarseness for the past several months was referred to our hospital.
Imaging Findings
The patient had been affected for the past several months by a cough and hoarseness. Indirect laryngoscopy showed a marked submucosal swelling of the paralaryngeal space involving the left false
vocal cord; the mass was found to be soft, compressible and enlarged, when examined with Valsalva’s maneuver. A computed tomography (CT) image showed a large left, air-filled internal
laryngocele without rim enhancement.
Discussion
A laryngocele is an uncommon disorder of the larynx, representing up to 5% of all benign laryngeal lesions. It is a cystic dilatation of the laryngeal saccule. Although its origin is unclear, it is
probably related to an abnormal increase of the intralaryngeal pressure. Clinically, most laryngoceles are found to be asymptomatic and are often detected when neck examinations are performed for
unrelated symptoms. When symptomatic, patients with internal laryngoceles may present with hoarseness, a neck mass, airway obstruction, a sensation of “fullness” in the throat, dysphagia
and/or dyspnea. Imaging studies are essential in the diagnosis and the management of laryngoceles. Laryngoceles may be classified as either internal (20%), external (30%) or mixed (50%), and may be
unilateral (85%) or bilateral (15%). An internal laryngocele remains in the paralaryngeal space and lies medial to the thyrohyoid membrane. Clinically, it is usually seen as a swelling of the false
vocal cord and the aryepiglottic fold. An external laryngocele extends superiorly and penetrates through the thyrohyoid membrane. A laryngocoele may be air-filled, or become filled with fluid or
mucus. When a laryngocele becomes infected, a laryngopyocele results. A CT scan is considered to be more sensitive than physical examination and laryngoscopy in the detection of a laryngocele. An
imaging study helps in determining the exact extent of a laryngocele and its content (air or mucus) and the relationship between the ventricle and the thyrohyoid membrane. A laryngopyocele may have a
peripheral rim enhancement. The mucoid or purulent contents may have a CT density similar to that of the adjacent soft tissue. Each time a laryngocele is detected, it is essential to exclude the
presence of a tumoral lesion at the level of its orifice between the true and the false vocal cords; laryngeal neoplasms may present indirectly with a secondary laryngocele.
Differential Diagnosis List