A 40-year-old man presents with intermittent hoarseness and a feeling of fullness in the throat. Endoscopy shows a smooth, fluid-filled swelling above the right false cord that communicates with the laryngeal ventricle; it intermittently decompresses and his voice improves transiently. CT shows the sac confined within the thyroid cartilage. What is the diagnosis and its distinguishing feature?

• A Mixed external laryngocele, filled with air and crossing the thyrohyoid membrane
• B Saccular cyst, extending through the thyrohyoid membrane into the neck
• C Internal laryngocele, confined within the thyroid cartilage and communicating with the ventricle ✓
• D Laryngeal mucocele secondary to saccule malignancy

Explanation

C laryngocele is an abnormal dilatation of the saccule. An internal laryngocele remains confined within the thyroid cartilage and communicates with the ventricular lumen, producing variable hoarseness and fullness. An external or mixed laryngocele herniates through the thyrohyoid membrane and presents as a neck swelling that enlarges with Valsalva and is resonant to percussion. C saccular cyst is blocked and does not communicate with the airway, which excludes option B.

Reference: Scott-Brown's Essential Otorhinolaryngology, 3rd ed.

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Written and medically reviewed by the StethoPrep medical team.