Aspetti radiologici peculiari in caso di nuococele laringeo misto

In laryngeal mucocele, Morgagni's ventricle fills with mucous resulting from proliferation of the innner glandular epithelium and simultaneous closure of the ventricular opening. In making a diagnosis, the physician must first rule out any underlying neoplasm in Morgagni's ventricle which would give rise to a secondary mucocele. The present work reports a clinical case which came under observation because of cough, dysphonia and swelling of the left ventricular band with normal motility of the true vocal cords. CT of the neck, performed with contrast medium and axial scanning, showed a solid neoformation starting from the left laryngeal ventricle; densitometry proved moderately non homogeneous and showed radiological signs of hypervascularization. On the basis of these data the patient underwent direct bioptic laryngoscopy. During the beginning of the endoscopic maneuver, the pressure exerted by the stiff laryngoscope forced out dense, sticky mucous-like material and caused the laryngeal ventricle to collapse. Subsequently, multiple bioptic samples were taken from the walls and floor of the ventricle. The histological and microbiological examination confirmed the diagnosis of laryngeal mucocele. Six months later the laryngoscopic picture was nearly normal. In the years since computerized tomography came into clinical practice, diagnosis of this pathology has become easier and quicker Computerized tomography provides radiological indication of benignness which is certainly valid for laryngocele, a tumefaction containing air and which is therefore clearly differentiated from the radiodensity of the surrounding tissues. Vice versa, the homogeneous mucous content of the laryngeal mucocele can be altered by bacterial proliferation and may not show up on the CT as a uniformly hypodense area. Phlogosis due to the presence of colonies of bacteria can lead to greater blood flow in the ventricular site, thus making it impossible to distinguish the hyperdense boundary surrounding the hypodense mass. This, in turn, creates a blurry, ambiguous area of hyperdensity typical of increased vascularization. The rarity of the lesion, the relative likelihood of a simultaneous neoplasm and the ambiguousness of the clinical diagnostic elements available justify the use of preliminary bioptic microlaryngoscopy before surgically treating laryngeal mucocele.