Laryngocele is an abnormal dilatation of the appendix of the laryngeal ventricle (ventricle of Morgagni) with air or fluid. The appendix is the anterosuperior extension of the laryngeal ventricle, normally 1-2 cm in length; in laryngocele, this structure abnormally dilates. Three anatomic types are defined: internal (within the paraglottic space, protruding into the laryngeal lumen), external (extending through the thyrohyoid membrane into neck soft tissue), and mixed (both components). Contents are named accordingly: air = simple laryngocele, mucus = laryngomucocele, purulent material = laryngopyocele. Associated with glass blowers, brass instrument musicians, and occupations with increased intralaryngeal pressure. Associated laryngeal carcinoma possibility (10-15%) requires careful evaluation of the ventricle region.
Age Range
40-75
Peak Age
60
Gender
Equal
Prevalence
Uncommon
Laryngocele pathogenesis is based on abnormal dilatation of the laryngeal ventricle appendix saccule. The normal appendix is the anterosuperior extension of the laryngeal ventricle, extending to the inner surface of the thyrohyoid membrane. Two main mechanisms cause dilatation: 1) Increased intralaryngeal pressure (glass blowing, brass instrument playing, chronic cough) — repeated pressure increases push and expand the appendix mucosa; 2) Obstruction of the ventricle ostium (most commonly by an associated laryngeal carcinoma) — obstruction followed by accumulated secretions or air passively expands the appendix. In air-filled laryngoceles, size increase with Valsalva maneuver is expected because increased intralaryngeal pressure pushes air into the appendix. Mucocele formation results from inability to drain mucus secretion after ventricle ostium obstruction — this scenario mandates investigation for associated carcinoma. In infected pyocele, bacterial colonization leads to inflammation and may spread to surrounding soft tissues.
Air- or fluid-filled cystic structure in the paraglottic space at the laryngeal ventricle level — pathognomonic size increase with Valsalva maneuver. Possibility of carcinoma obstructing the ventricle ostium should be investigated.
On non-contrast CT, a smooth-bordered cystic structure at air density (-1000 HU) is seen in the paraglottic space at the laryngeal ventricle level. In the internal type, the lesion is located within the laryngeal lumen and may narrow the glottic airway. In the external type, it extends through the thyrohyoid membrane into neck soft tissue. In the mixed type, both components are present. The wall is thin and smooth, with no enhancement.
Report Sentence
A smooth-bordered cystic structure at air density is seen in the left paraglottic space at the laryngeal ventricle level, consistent with an internal laryngocele.
On MRI, laryngocele shows different signal characteristics depending on its contents. Air-filled simple laryngocele shows signal void on T1 and T2. Fluid-filled mucocele shows T1 hypointense, T2 markedly hyperintense signal (fluid signal). Proteinaceous or purulent content shows mild T1 hyperintensity. No enhancement (if not infected); pyocele shows rim enhancement.
Report Sentence
A smooth-bordered cystic lesion showing T1 hypointense, T2 markedly hyperintense signal is seen in the left paraglottic space, consistent with a laryngomucocele.
In infected laryngopyocele, CT shows a fluid-filled (10-40 HU) cystic structure with rim enhancement, wall thickening, and surrounding fat stranding. An air-fluid level may indicate gas formation superimposed on infection. Clinically, fever, neck swelling, and pain are expected. Emergency intervention (incision-drainage) may be required.
Report Sentence
A fluid-filled cystic lesion with rim enhancement and surrounding fat inflammatory changes is identified in the left paraglottic space, consistent with an infected laryngopyocele.
In external laryngocele, an air- or fluid-filled cystic structure extending through the thyrohyoid membrane into neck soft tissue is seen. A 'waist sign' may be visible at the thyrohyoid membrane level — narrowing at the point where the cystic structure passes through the membrane. It presents as a palpable neck swelling and pathognomonic size increase with Valsalva maneuver.
Report Sentence
An air-filled cystic structure extending from the left paraglottic space through the thyrohyoid membrane into neck soft tissue is seen, consistent with a mixed-type laryngocele.
External laryngocele can be assessed with neck US: a smooth-bordered cystic structure showing anechoic (fluid-filled) or hyperechoic reverberation artifact (air-filled) above the superior border of the thyroid cartilage. Real-time size change with Valsalva maneuver can be demonstrated — this is pathognomonic. In infected pyocele, thickened, irregular wall and internal echoes may be seen.
Report Sentence
An anechoic cystic structure is seen above the superior border of the left thyroid cartilage, showing size increase with Valsalva maneuver, consistent with an external laryngocele.
Criteria
Confined within paraglottic space, does not cross thyrohyoid membrane
Distinct Features
Risk of airway obstruction, not visible externally, diagnosed by CT/MRI
Criteria
Extends through thyrohyoid membrane into neck soft tissue
Distinct Features
Palpable neck swelling, enlarges with Valsalva, assessable with US, waist sign
Criteria
Infected laryngocele — purulent contents
Distinct Features
Fever, pain, rim enhancement, wall thickening, fat stranding, emergency drainage may be needed
Distinguishing Feature
SCC solid enhancing mass; laryngocele cystic/air-filled, no enhancement (if not infected)
Distinguishing Feature
Paralysis ventricle enlargement (from dilatation, no mass); laryngocele cystic structure originating from ventricle appendix
Distinguishing Feature
Chondrosarcoma solid calcified mass; laryngocele cystic, no calcification
Urgency
routineManagement
surgicalBiopsy
Not NeededFollow-up
6-monthAsymptomatic laryngocele may be followed. Symptomatic cases (airway obstruction, infection) require surgical excision (endoscopic or open). Infected pyocele may need emergency drainage. Ventricle region should be carefully evaluated due to possibility of associated laryngeal carcinoma — endoscopic biopsy is recommended.
Laryngocele is usually asymptomatic but can cause airway obstruction. Infected laryngopyocele may require emergency intervention. Due to the possibility of associated laryngeal carcinoma, the ventricle region should be carefully evaluated. Treatment is surgical excision (endoscopic or open) in symptomatic cases. Prognosis is excellent but recurrence may occur.