Imaging larynx 2 nd part laryngeal congenital inflammatory traumatic ct mri dr ahmed esawy Laryngomalacia Ductal retention cyst Cystic hygroma Bifid epiglottis Vocal cord paralysis Web and atresia Interarytenoid web Posterior laryngeal cleft Cri-du-chat syndrome Cong. Subglottic stenosis Subglottic hemangioma Web & atresia Cysts Croup Epiglottic Enlargement Epiglottitis Squamous cell carcinoma is mucosal disease Glottic carcinoma subglottic carcinoma supraglottic carcinoma virtual laryngoscopy vocal cord paralysis Hyiod bone Laryngeal skeleton the paired 1- arytenoid, 2- corniculate 3- cuneiform cartilage the unpaired 4- thyroid 5- cricoid 6- epiglottic cartilages supraglottic 7- Valleculae 8- Aryepiglottic fold 9- Glossoepiglottic fold 10- Laryngeal vestibule 11- False cord 12- Ventricle 13- Preepiglottic space

1. Congenital disorders of the Larynx
Supraglottic Glottic Subglottic
Laryngomalacia Vocal cord paralysis Cong. Subglottic
stenosis
Ductal retention cyst Web and atresia Subglottic hemangioma
Cystic hygroma Interarytenoid web Web & atresia
Bifid epiglottis Posterior laryngeal cleft Cysts
Saccular cyst Cri-du-chat syndrome
Anterior laryngeal cleft
Dr AHMED ESAWY

2. Subglottic stenosis
• Membranous and cartilaginous types.
• Membranous: fibrous soft-tissue thickening of
the subglottic area
• Cartilaginous: thickening or deformity of the
cricoid cartilage  shelf-like plate
• Grading of laryngeal stenosis
– Grade I Less than 70%
– Grade II 70%-90%
– Grade III More than 90%;
– Grade IV Complete obstruction

3. Subglottic stenosis
Dr AHMED ESAWY

4. Subglottic Stenosis
Laryngeal conditions

5. ( laryngocele)
• diltation of ventricular saccule or appendix
• Usually acquired
• Laryngomucocele Saccular cyst if fluid filled
• Laryngocele if air filled
• pyolaryngocele; is an infected laryngocele,
filled with pus, is called a it shows a thickened
wall on cross-sectional imaging
• Laryngocele is supragglottic abnormality and
the true cord is normal

6. Laryngocele
• classifications: internal, external, and combined.
• The internal (40%) component is medial to the hyoid
bone,inside larynx
• the external (26%)component lateral to the hyoid.
• Mixed (44%) laryngocele on both side of thyriod
memberane.
• etiology
–  transglottic pressure, e.g. in trumpet players,excessive cough
– laryngeal carcinoma  partial obstruction
– Congenital
– Search for underlying laryngeal cancer

7. Laryngocele internal,
external, and combined

8. • acquired
laryngocele

9. • Mixed laryngocele. Enhanced CT reveals an air-filled
laryngocele straddling the thyrohyoid membrane. The internal
component (arrowhead) is medial to the hyoid bone (asterisk)
and the external component (arrow) is lateral to the hyoid.

10. Dr AHMED ESAWY

11. • Trachea radiograph: At the level of the larynx, on the right side,
a peanut-sized saccular protrusion can be seen (arrow).
• EXTERNAL ONLY THAT APPEAR ON X-RAY

12. Laryngocele Saccular cyst
fluid filled

13. • Axial contrast-enhanced CT
image through supraglottic
larynx. Bilateral fluid-filled
internal laryngocele(saccular
cyst) (arrows).
Dr AHMED ESAWY

14. SACCULAR CYST © LARYNGOCELE
AXIAL POST GADOLINIUM

15. cysts
• Three types
• 1-saccular cyst ( laryngocele)
• 2-mucosal cyst arise within the larynx
• 3-thyroglossal duct cyst arise just outside
the larynx in close assosciation with the
strape muscles

16. SACCULAR CYST (LARYNGOCELE) (L)

17. THYROGLOSSAL DUCT CYST
PARAGLOTTIC FAT (ARROWHEAD)

18. • Axial CT scan of the neck showing the epiglottic
cyst in the pictures above.

19. INJURIES OF THE LARYNX
• Results:
• Trauma may result in:
• Cartilage fracture.
• Mucosa  lacerations.
• Submucosa  Hge.
• Membranes  rupture and surgical
emphysema

20. Overview
• Classification of Trauma
– Blunt
– Penetrating
– Inhalation
– Ingestion
– Iatrogenic

21. VERTICAL FRACTURE OF THE LARYNX

22. Laryngeal Fracture
• The above axial CT scan shows a fracture of the thyroid
cartilage lamina. Note the presence of an endotracheal tube

23. Laryngeal F.B.
Complete Obstruction: Death
Incomplete Obst.: cough, dyspnea, Aphonia
Coin In Larynx

24. ARYTENIOD DISLOCATION
CRICIOD ARROWHEAD
ARYTENIOD ARROW

25. inflammatory

26. Epiglottitis

27. • Epiglottitis is the inflammation of the
supraglottic structures

28. Radiographic parameters in adult
epiglottitis
• The measurement differences were
significant between the groups only for
the width of the epiglottis and
aryepiglottic folds
•
• Width of the epiglottis greater than 8
mm and of the aryepiglottic folds
greater than 7 mm seem highly
suggestive of epiglottitis in the adult.

30. Sites of measurement of
aryepiglottic folds and epiglottis
1-width of aryepiglottic folds at
the mid piont of these folds
2- 1-width of aryepiglottic folds
behind epiglottis
3= 1-width of aryepiglottic folds
at the base of these folds

32. Epiglottis and
aryepiglottic
folds thickened
in epiglottitis

33. Classic thumprint appearance of a
swollen epiglottis is pathogonomonic
Of epiglottitis (lateral view /erect)

34. • CT scan in an adult with acute epiglottitis shows a column of air around the
epiglottis (E). The right side is more swollen than the left, and the
hypoattenuating area (A) is suggestive of fluid or an early abscess formation.

35. • A, Axial contrast-enhanced CT scan at the level of the hyoid bone shows marked thickening of
the aryepiglottic folds (f), posterior pharyngeal wall, and platysma muscle (arrow). B, Edema is
seen in the retropharyngeal space extending to the carotid arteries bilaterally (asterisks) and
in the subcutaneous fat. There is obliteration of the paraglottic fat planes and thickening of the
false vocal cords (V).

36. CROUP
• SUBGLOTTIC LARYNGITIS

37. Croup Vs Epiglottitis
Characteristics of Laryngotracheitis and Epiglottitis
Feature Laryngotracheitis Epiglottitis
Age <3 years >3 years
Onset Gradual (days) Acute (hours)
Cough Barky Normal
Posture Supine Sitting
Drooling No Yes
Radiograph Steeple sign, narrowed subglottis Thumb sign, enlarged
epiglottis,dilated hypopharynx
Cause Viral Bacterial
Treatment Supportive (croup tent) Airway management (intubation or
tracheotomy), antibiotics

38. CROUP is best appreciated on the AP view
And can be distinguished from congenital
Subglottic stenosis and post-intubation
oedema by history
The characteristic church stipple
appearances of croup results
From subglottic oedema obliterating the
normal subglottic shoulder
Of the proximal airway

39. CROUP is best appreciated on the AP view
And can be distinguished from congenital
Subglottic stenosis and post-intubation
oedema by history
The characteristic church stipple
appearances of croup results
From subglottic oedema obliterating the
normal subglottic shoulder
Of the proximal airway

40. Epiglottic Enlargement
• NORMAL VARIANT
– Prominent normal epiglottis
– Omega epiglottis
• INFLAMMATION
– Acute / chronic epiglottitis
– Angioneurotic edema
– Stevens-Johnson syndrome
– Caustic ingestion
– Radiation therapy
• MASSES
– Epiglottic cyst
– Aryepiglottic cyst
– Foreign body

41. Aryepiglottic Cyst
• Retention cyst
• Lymphangioma
• Cystic hygroma
• Thyroglossal cyst
• may be symptomatic at birth
• well-defined mass in aryepiglottic
fold

42. • Diphtheria.. The laryngeal cartilages are collapsed and the laryngeal airway
occluded. The thyroid (arrowheads) and cricoid (arrow) cartilages are misshapened.
The distance between thyroid and cricoid cartilage is diminished.

43. Chronic Localized Hypertrophic
Laryngitis:
• Vocal (Singer’s) nodules:
• Etiology:
• Prolonged abuse of voice. Occurs commonly in
untrained voice users as singers and teachers.
• Pathology:
• Localized epithelial hyperplasia and/or sub-
epithelial organized haematoma of the vocal
fold.

44. • Singer’s nodules.
Dr AHMED ESAWY

45. Vocal cord polyps (papilommas)
• Etiology: usually complicates an
acute violent voice trauma e.g.
shouting.
• Pathology: Localized sub-epithelial
edema (edematous polyp), vascular
engorgement (vascular polyp) or
fibrosis (fibrotic polyp) of the vocal
fold.

46. Dr AHMED ESAWY