A 32-year-old professional trumpet player notices a soft swelling above the left clavicle that enlarges when he plays and reduces at rest. Flexible laryngoscopy shows a smooth air-filled bulge in the left supraglottic region communicating with the ventricle. What is the most likely diagnosis?
- A Internal laryngopyocele
- B Saccular cyst filled with mucus
- C Mixed external and internal laryngocele ✓
- D Lateral thyroglossal duct cyst
Correct answer: C. Mixed external and internal laryngocele
Explanation
A laryngocele is an abnormal air-filled dilatation of the laryngeal saccule that communicates with the laryngeal ventricle. Raised intraglottic pressure from activities such as playing wind instruments or glassblowing predisposes to it. When the sac herniates through the thyrohyoid membrane it produces an external neck swelling that expands with Valsalva, while retaining its internal component visible on endoscopy, making this a mixed laryngocele. A saccular cyst is fluid filled and does not enlarge with blowing.
Reference: Scott-Brown's Otorhinolaryngology Head and Neck Surgery, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.