A Case Report of Huge Pyolaryngocoele with Airway Compromisation

Mohamed Elghobashy*, Enas Alaqeab, Cornelius J. Sauerman, Abdul Matin and Alaa Almanassra

Department of ENT and Head and Neck, University Hospital Limerick, co. limerick, Ireland

^*Correspondance to: Mohamed Elghobashy 

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Abstract:

Pyolaryngocele is a very rare and serious complication of laryngocoele. The clinical presentation can be extremely severe, acute epiglottitis with laryngeal dyspnea and major dysphagia. The treatment of choice is surgical excision. Our aim is to attract the intention of the surgeon to this unusual entity and describe its clinical features. We report a case of a 70-year-old female patient with history of sore throat, difficult swallowing, low-grade fever and hoarseness of voice with difficulty of breathing and left side neck lump following acute tonsilitis 10 days before. An emergent flexible nasolaryngoscopy was done after patient’s consent and showed suproglottic bulge especially at the left saccule. An urgent CT scan showed a left side mixed laryngocoele with significant mass effect on the glottic and supraglottic airway with surrounding inflammatory changes suggesting superimposed infection. The management consisted of high dose of intravenous amoxicillin, then the patient was admitted in intensive care unit due to airway compromisation and intubated till internal incision and drainage then she had improved and extubated. Then after completing the antibiotic course, the patient was discharged for improvement. 3 months later, she attended with recurrence of symptoms with worsening hoarseness and external neck swelling but no stridor. Flexible nasolaryngoscopy was done and revealed left vallecular swelling compressing the epiglottis and shifting it to right with bilateral mobile vocal cords. Intravenous ceftriaxone and metronidazole were given then Urgent CT neck was done and showed recurrent pyolaryngolcele with obvious collection, so external aspiration of about 20 ml of pus was done. There was no growth on pus culture. The cytology reflected benign nature with mucoid material including sheets of inflammatory degenerate cells. Then, the patient has improved dramatically as regard her neck swelling and voice quality. Flexible nasolaryngoscopy was done before discharing the patient which showed marked improvement with no suprglottic bulge and nearly normal supraglottic and glottic areas. Now, we are preparing the patient for excision of the residual laryngocoele via an external approach.

Keywords:

Pyolaryngocele, Laryngocele, Neck mass, Deep neck infection

Cite the Article:

Elghobashy M, Alaqeab E, Sauerman CJ, Matin A, Almanassra A. A Case Report of Huge Pyolaryngocoele with Airway Compromisation. Ann Clin Case Rep. 2025; 10: 2784..