1. CASE PRESENTATION
A 64‐year‐old male with a medical history of thyroglossal duct cyst presented to the emergency department with dysphagia. The patient noted progressive dysphagia and neck pain over 2 weeks and was unable to tolerate solid foods. Examination revealed a large anterior neck mass. He was able to tolerate secretions and free of trismus. Computed tomography was obtained showing a large cystic left neck lesion with mass effect on the airway (Figures 1 and 2). Fiberoptic nasopharyngoscopy was performed confirming large supraglottic cystic mass obstructing 90% of the glottis (Figure 3). Otolaryngology (ENT) was then consulted.
FIGURE 1.
Coronal computed tomography (CT) with supraglottic mass.
FIGURE 2.
Axial computed tomography (CT) with obstructed airway.
FIGURE 3.
Fiberoptic scope and supraglottic mass.
2. DIAGNOSIS: LARYNGOPYOCELE
Following evaluation by ENT, the large cystic mass was diagnosed as laryngopyocele. The area was anesthetized, and an 18‐gauge needle was introduced to the left anterior neck mass (Video 1). Dark, murky fluid (220 mL) was aspirated with complete resolution of the mass (Figure 4, Video 2). The patient was started on augmentin and discharged with outpatient follow‐up. At the time of follow‐up, the patient denied any recurrence of dysphonia, dyspnea, or dysphagia.
VIDEO 1.
Pre‐drain of mass.
FIGURE 4.
Fiberoptic scope with patent airway after drainage.
VIDEO 2.
Post‐drain of supraglottic mass.
A laryngopyocele is an extremely rare entity with less than 70 reported cases as of 2015. 1 , 2 A laryngocele is an abnormal cystic dilation of the laryngeal ventricle that once obstructed fills with glandular secretions and becomes a laryngomucocele. When the laryngomucocele becomes infected, the resultant structure is known as a laryngopyocele. 3 The conversion from laryngocele/laryngomucocele to laryngopyocele is believed to be less than 10%. 4 Associated complications of laryngopyoceles include airway obstruction, which can be fatal, as well as aspiration of purulent fluid with resultant pulmonary injury. 5
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
Millard JT, Bloom AD. Adult male with dysphagia. JACEP Open. 2024;5:e13165. 10.1002/emp2.13165
This work was not presented at any meetings.
REFERENCES
- 1. Aslaner MA. Laryngopyocele: a deep neck infection diagnosed by emergency ultrasound. Am J Emerg Med. 2018;36(11):2132.e5‐2132.e7. doi: 10.1016/j.ajem.2018.08.026 [DOI] [PubMed] [Google Scholar]
- 2. Al‐Yahya SN, Baki MM, Saad SM, Azman M, Mohamad AS. Laryngopyocele: report of a rare case and systematic review. Ann Saudi Med. 2016;36(4):292‐297. doi: 10.5144/0256-4947.2016.292 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Vasileiadis I, Kapetanakis S, Petousis A, Stavrianaki A, Fiska A, Karakostas E. Internal laryngopyocele as a cause of acute airway obstruction: an extremely rare case and review of the literature. Acta Otorhinolaryngol Ital. 2012;32(1):58‐62. [PMC free article] [PubMed] [Google Scholar]
- 4. Mahdoufi R, Barhmi I, Khallouq A, Abada R, Roubal M, Mahtar M. Mixed pyolaryngocele: uncommon presentation of deep spaces neck infection. Ann Med Surg. 2016;10:49‐51. doi: 10.1016/j.amsu.2016.07.026 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Robert Munashe Maweni J, Shirazi S, Chatzoudis D, Das S, Laryngopyocoele with contralateral laryngocoele: a rare cause of respiratory distress. Case Rep. 2018;2018. doi: 10.1136/bcr-2018-225444 [DOI] [PMC free article] [PubMed] [Google Scholar]