A 40-year-old glass blower notices a soft swelling in the right side of his neck that enlarges when he blows against resistance and reduces with gentle pressure. Flexible laryngoscopy shows a smooth air-filled bulge of the right false vocal cord communicating with the laryngeal ventricle. The most likely diagnosis is:

• A External laryngocele ✓
• B Thyroglossal cyst
• C Branchial cyst
• D Laryngeal saccular cyst filled with mucus

Explanation

A laryngocele is an abnormal air-filled dilatation of the saccule, the appendix of the laryngeal ventricle. When the sac herniates through the thyrohyoid membrane it becomes an external laryngocele, producing a neck swelling that enlarges on Valsalva and is resonant to percussion. Raised intralaryngeal pressure occupations such as glass blowing and trumpet playing predispose to it. A saccular cyst contains mucus, does not communicate freely with the airway, and does not vary with Valsalva.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.