Bilateral Laryngoceles

Abstract

A 63-year old male with a prior history of anterior cervical discectomy and fusion presented with complaints of gradual dysphagia with occasional regurgitation of undigested food and primarily a right neck swelling. Radiographic FeaturesAxial computed tomography (CT) imaging (Fig. 1) demonstrated bilateral, cystic, air filled lesions extending into the soft tissues of the neck, with the right (4.8 9 2.5 9 4.5 cm) larger than the left (1.3 9 1.1 9 1.2 cm), each fully pneumatized without fluid collection. No nodularity was associated with the walls of either and no associated mass lesion was present about the laryngeal ventricles. The right lesion showed extension through the thyrohyoid membrane with mass effect upon the supraglottic larynx, and the left showed sole placement within the soft tissues of the neck. Regionally, no additional mass lesions or adenopathies were identified. Changes of the prior C3 through C7 cervical spine fusion were observed. No mass lesion was present at either lung apex (Fig. 2). DiagnosisThe hematoxylin and eosin (H&E) stained sections obtained from the right-sided lesion revealed a complex cystic structure of respiratory type epithelium composed of psuedostratified ciliated epithelium of varying thickness set against a background of variably dense, chronically-inflamed fibrous connective tissue (Fig. 3). The left sided lesion (Figs. 4,5) showed prominent respiratory-type epithelium lining the cystic areas as well as adjacent mature adipose tissue, seromucous glands, and prominent vascularity observed in the periphery. The combination of imaging studies, histology and location confirmed a diagnosis of bilateral laryngoceles.

Laryngeal Cysts in Adults: Simplifying Classification and Management

“…Computed tomography (CT) is the cross-sectional imaging modality of choice in the first instance, with 2-mm axial images sufficient to exclude unexpected cystic extension or a large occult lesion. 43 Infected lesions show ring enhancement with contrast CT. 44 Magnetic resonance imaging (MRI) is superior at differentiating soft tissue and may distinguish obstructed mucus and inflammation from neoplastic disease. 45 MRI is especially important in the evaluation of presumed saccular abnormalities with the ventricle, saccule, paralaryngeal space, with the thyrohyoid membrane clearly demarcated.…”

Lumps and Bumps of the Neck in Children—Neuroimaging of Congenital and Acquired Lesions

“…They may arise from congenital anomalous large saccules with a potential subsequent narrow ventricular orifice and demonstrate progressive expansion with increased intraluminal laryngeal pressure (eg, crying). Acquired laryngoceles are often associated with laryngeal carcinoma causing (partial) occlusion of the ventricular orifice …”

“…Acquired laryngoceles are often associated with laryngeal carcinoma causing (partial) occlusion of the ventricular orifice. 12,28,29 Saccular cysts are saccular dilatations filled with mucus and develop secondary to atresia of the orifice of the ventricle (congenital) or obstruction of the ventricular orifice due to mucus retention (acquired). 6,28 Both laryngoceles as well as saccular cysts demonstrate similar modes of potential distension and expansion through structurally weak areas of the larynx.…”

Laryngopyocele: a rare neck mass and an uncommon excision

“…Several cases have reported the coexistence of saccular cysts and laryngeal carcinoma or amyloidosis, potentially as the causative agent. It is hypothesized that an increase in intraluminal pressure by obstruction of upper airways, speech effort, excessive coughing and/or local mechanical conditions is the underlying pathology . A thorough investigation including an MLN examination prior to excision, particularly with a previous smoking history, to exclude occult squamous cell carcinoma in the ventricle causing the laryngocele is imperative.…”

“…It is hypothesized that an increase in intraluminal pressure by obstruction of upper airways, speech effort, excessive coughing and/or local mechanical conditions is the underlying pathology. 9 A thorough investigation including an MLN examination prior to excision, particularly with a previous smoking history, 10 to exclude occult squamous cell carcinoma in the ventricle causing the laryngocele is imperative. It is also important to note that laryngeal tuberculosis or syphilis can cause prolapse of the ventricle and saccule into the airway causing obstruction.…”