Primary Aspergillosis of Bilateral Laryngoceles

Laryngocele is an abnormal dilatation of the saccule of laryngeal ventricle, which is usually unilateral and filled with air or fluid. We present a case of bilateral laryngoceles colonized by Aspergillus species. 1. Introduction Laryngocele is an uncommon condition characterized by abnormal dilatation and elongation of the saccule of laryngeal ventricle of Morgagni [1]. It may be classified as internal, external, or mixed. The usual presentation is of a swelling in the upper neck and diagnosis is confirmed radiologically, primarily by means of computed tomography. Connection between the air sac and the airway helps to establish the diagnosis. Surgery is indicated for symptomatic laryngoceles. Laryngocele can be air-filled or fluid-filled. Bacterial infection can result in pus formation (laryngopyocele). Colonization with fungal infection such as Aspergillus species was not previously described. Aspergillosis, which can be defined as an infection or disease caused by fungi in the genus Aspergillus, constitutes a wide range of disease entities that form a continuum from allergic reactions to disseminated invasive disease in immunocompromised patients [2]. 2. Case Report A 77-year-old lady presented to ENT clinic with 4-month history of worsening dysphagia to solids and liquids and difficulty of talking. Past medical history includes smoking and asthma for which she was on inhaled corticosteroids. On examination, there was no stridor but the patient was dysphonic. Her oral cavity, oropharynx, and neck examination were unremarkable. Fibreoptic nasoendoscopy revealed large bilateral supraglottic masses centered on the aryepiglottic folds. The right tumour was significantly larger than the left and encroached on the laryngeal inlet. The left vocal cord was mobile but the right cord was fixed. There was significant luminal narrowing with only 30% of the airway remaining visible. A CT scan of the neck (Figures 1 and 2) showed bilateral large well-defined homogenously hyperdense glottic and supraglottic masses, centered on the paralaryngeal fat and extending from the hyoid bone to the true cords. Figure 1: Axial contrast enhanced CT scan at the level of true vocal cords showing bilateral solid paraglottic masses (arrows) narrowing the laryngeal lumen (asterisk). Figure 2: Both masses are medial to the thyrohyoid membrane in keeping with internal laryngoceles. Note how the pyriform sinus (arrow head) is almost completely effaced. Thyroid cartilage (arrow). Hyoid bone (interrupted arrow). A communication with the laryngeal ventricle was not clear; therefore, the