The trumpet player with a swelling in the neck

Abstract

Bilateral neck swelling in patients following valsalva manouveres could lead to a diagnosis of either a pharyngocele or laryngocele. Distinguishing between them can be complicated but is vital given the possibility for an acute airway in patients with laryngoceles. A 20-year-old trumpet player presents with a 5-year history of neck swelling. Clinical suspicion is that of a pharyngocele but imaging introduces some confusion with the diagnosis. Both pharyngoceles and laryngoceles can occur as a result of prolonged positive pressure. Accurate assessment with fibreoptic examination and imaging is needed to confirm the diagnosis. Pharyngoceles are often misdiagnosed as laryngoceles. Though treatment is similar between the two patient groups it is vital that a distinction is made to enable careful observation of the airway in patients with laryngoceles.

Figure 1

Inspection of the patient’s neck (A) at rest (B) during trumpet playing.

Figure 2

Fibreoptic examination of the supraglottic structures (A) at rest and (B) during trumpet playing revealing the grossly enlarged piriform fossa.

Figure 3

(A) Axial slice from CT neck demonstrates large bilateral air spaces during trumpet playing, (B) Reformatted coronal slice from CT revealing extent of the pharyngocele.

Figure 4

Still image from barium swallow revealing normal hypopharynx.

Figure 5

Diagram showing the difference between a pharyngocele (2) and a laryngocele (5); and (1) hyoid, (2) pharyngocele, (3) thyroid, (4) cricoid, (5) external laryngocele, (6) thyrohyoid membrane, (7) vestibular folds and (8) vocal folds.