Reinke edema (polypoid corditis) is a bilateral, diffuse polypoid swelling that develops from accumulation of polysaccharide-rich gelatinous fluid in the Reinke space (superficial layer of the lamina propria — loose connective tissue between the vocal ligament and epithelium) of the vocal cords. The strongest risk factor is smoking (smoking history in 97% of patients). Vocal abuse (excessive voice use) and GERD are other triggers. Presents with voice deepening and dysphonia. In advanced cases, polypoid swelling may narrow the airway lumen. On imaging, smooth-bordered, non-enhancing, bilateral vocal cord swelling is characteristic.
Age Range
40-70
Peak Age
55
Gender
Female predominant
Prevalence
Common
The Reinke space is the loose connective tissue layer located just beneath the vocal cord epithelium. This space normally contains small amounts of mucopolysaccharide and hyaluronic acid. Toxic substances in cigarette smoke (acrolein, formaldehyde) damage the vascular endothelium in the Reinke space — capillary permeability increases and plasma proteins extravasate. The chronic inflammatory response triggers fibroblast activation — excessive mucopolysaccharide production occurs. This gelatinous material accumulates in the Reinke space and diffusely swells the vocal cords. Bilaterality reflects equal exposure of both cords to cigarette smoke. On imaging: fluid accumulation creates high signal on T2 (free water); minimal or no enhancement due to vascular damage (decreased fibrovascular tissue); smooth margins indicate absence of tissue invasion — the most critical distinguishing feature from SCC. Low density on CT results from the near-water density of edema fluid.
Diffuse, symmetric polypoid swelling in the Reinke space of both vocal cords. Low density, no enhancement, smooth margins — pathognomonic distinction from SCC.
On contrast-enhanced CT, bilateral vocal cords are diffusely thickened with polypoid appearance. Thickened cords show low density (edema fluid, 15-30 HU). No or minimal enhancement. Margins are smooth, may be lobulated but not infiltrative. Glottic airway lumen may be narrowed due to bilateral swelling. Important: no erosion or invasion of thyroid and cricoid cartilages — critical for excluding SCC.
Report Sentence
Bilateral vocal cords are diffusely thickened with polypoid appearance (each cord thickness approximately __ mm). No enhancement is seen. Margins are smooth. No cartilage erosion or invasion is present. Glottic airway lumen is [preserved/narrowed]. Findings are consistent with Reinke edema (polypoid corditis).
Marked, homogeneous hyperintensity is seen in bilateral vocal cords on MRI T2-weighted sequences. Signal becomes even more conspicuous with fat suppression on STIR. While normal vocal cords show low-intermediate signal on T2, Reinke edema creates dramatic signal increase. No or minimal enhancement on post-contrast sequences.
Report Sentence
Marked homogeneous hyperintensity is seen in bilateral vocal cords on MRI T2 sequences. No enhancement is seen on post-contrast sequences. Findings are consistent with Reinke edema.
On non-contrast CT, bilateral vocal cords are symmetrically thickened with smooth outer contours. Low density (near water density). Critical negative finding: no erosion, sclerosis, or invasion of thyroid cartilage, cricoid cartilage, and arytenoid cartilage. Paraglottic fat planes are preserved. These negative findings strongly exclude SCC.
Report Sentence
Smooth-bordered, low-density polypoid thickening is seen in bilateral vocal cords. No erosion or invasion of thyroid and cricoid cartilages is identified. Paraglottic fat planes are preserved. No findings favor SCC.
Reinke edema shows no diffusion restriction on DWI — ADC values are high. Diffusion movement of free edema fluid is unrestricted. This is an additional helpful finding for distinction from SCC: diffusion restriction is expected in SCC due to high cellularity.
Report Sentence
No diffusion restriction is seen in the vocal cord lesions on DWI. ADC values are high. No findings favor malignancy.
On transcervical ultrasonography, bilateral vocal cords are diffusely thickened and hypoechoic in appearance. Edema fluid causes low echogenicity. Margins are smooth. Vascularity is minimal or absent on Doppler (due to vascular damage). US can dynamically assess vocal cord mobility — bilateral cord movement is usually preserved in Reinke edema.
Report Sentence
On transcervical US, bilateral vocal cords are diffusely thickened and hypoechoic. Vascularity is minimal/absent on Doppler. Vocal cord mobility is [preserved/restricted].
Criteria
Minimal polypoid swelling, not narrowing the airway
Distinct Features
May regress with smoking cessation and voice therapy. Mild vocal cord thickening on imaging.
Criteria
Significant polypoid swelling, may narrow airway, may prolapse between vocal cords
Distinct Features
Requires surgical treatment (microlaryngoscopic excision). Airway compromise may occur.
Criteria
Unilateral involvement — rare, requires SCC exclusion
Distinct Features
In unilateral involvement, SCC must be excluded by biopsy. Smooth margins and absence of enhancement favor benign.
Distinguishing Feature
Granuloma is focal, on the vocal process; Reinke edema is diffuse, bilateral cord involvement.
Distinguishing Feature
Subglottic stenosis is at cricoid level; Reinke edema is at glottic level (vocal cords).
Distinguishing Feature
Epiglottitis is supraglottic (epiglottis); Reinke edema is glottic (vocal cords). Epiglottitis has fever and acute presentation.
Urgency
routineManagement
conservativeBiopsy
Not NeededFollow-up
6-monthPrimary treatment is smoking cessation, voice therapy, and GERD control. In advanced cases (airway compromise, severe voice impairment), microlaryngoscopic surgery (aspiration of gelatinous material from Reinke space) is performed. Prognosis is excellent with no risk of malignant transformation. However, follow-up for SCC is recommended due to smoking.
Treatment includes smoking cessation, voice therapy, and GERD control. Surgical excision (microlaryngoscopy) may be needed in advanced cases. Prognosis is excellent. No risk of malignant transformation, but SCC surveillance is recommended due to smoking.