Last Week's Medical Mystery

  This woman comes to you complaining of a painless swelling in her neck of one day's duration. She had been suffering from a respiratory infection for two weeks, with her main symptom being a relentless explosive cough. Her husband had similar respiratory symptoms. Her neck mass appeared abruptly after a particularly sever bout of coughing. You make a diagnosis merely by taking her history and looking at the swelling in her neck (pictured).

neck mass

DIAGNOSIS: laryngocele. A laryngocele is an abnormal dilation of the laryngeal saccule that extends upward from the false vocal fold; it is filled with air, and is in communication with the laryngeal lumen. Laryngoceles are categorized as internal (confined within the false vocal fold) or combined (internal and external, where the laryngocele has extruded through the thyrohyoid membrane to the neck, as in this case. Accumulation of mucous within the sac can produce a laryngomucocele, and secondary infection produces a laryngopyocele.

Laryngoceles can occur as a result of obstruction, or, as in this case, as a result of increased air pressure within the larynx. This case is unusual, but combined larygoceles are well described in persons whose professions cause chronic increases in laryngocele pressure (e.g., glass blowers and wind instrument players). In the absence of continued pressure, excess mucus collection, infection, or mechanical obstruction, larygoceles can be expected to resolve on their own - as was the case in this patient. Otherwise, surgical intervention may be necessary.