0:00

This was an example of a mass that's involving the per

0:05

laryngeal space at the level of supraglottic larynx.

0:09

The key finding here is that there's a mass involving the left per

0:14

laryngeal space. Okay?

0:17

And on some of the images right here, you can see it's low attenuation,

0:21

and on this image it looks a little bit higher attenuation.

0:25

So this actually turned out to be a laryn seal, but on the other hand,

0:30

this could easily have been squamous cell carcinoma as well too.

0:34

So if you said either lary seal or squamous cell carcinoma,

0:38

I think either of those are fine on this particular image.

0:42

I think if you do a hounds feel unit, you're gonna see its fluid collection.

0:46

So regardless, in real world situations,

0:49

if you see a mass that's involving the left perilaryngeal space,

0:53

the classic finding is that it should be cystic. And if it's cystic,

0:56

you could just go on and call it a lary seal. But on the other hand,

1:01

if you see anything that's solid,

1:04

then you often have to raise the possibility of a neoplasm. So,

1:09

um, let me stop there and take any questions.

1:12

And then what I'll do is I'll go ahead and bring up, um,

1:17

my PowerPoint. So we'll talk a little bit about laryn seals.

1:22

So the,

1:22

the laryngeal ventricle is situated between the false vocal cord and the true

1:27

vocal cord. So this is the normal laryngeal ventricle on the left hand side.

1:32

And in this particular case, we can see that there's narrowing here,

1:36

the laryngeal ventricle.

1:37

And we can see this dilatation of the laryngeal ventricle that's

1:42

extending laterally.

1:45

So laryngeals can either be air-filled as we see here.

1:49

And this is a nice example of a big dilatation of the laryngeal ventricle

1:54

extending to the paralytic space.

1:57

And if the laryn seal is isolated to the larynx,

2:02

as in the case that I showed you for the case of the wheat,

2:05

then that's referred to as an internal laryn seal.

2:08

But if the laryn seal extends laterally through the thyrohyoid membrane

2:13

and it extends into the soft tissue,

2:15

then this is what's referred to as an external laryngeal.

2:18

Or if it's in combine combination with an internal laryn seal,

2:22

an internal versus plus external laryn seal is known as a complex lary seal.

2:28

So it can either be due,

2:30

it can either be air-filled or it can be fluid filled as is seen here.

2:35

And this coronal images, again,

2:36

nicely demonstrates this laryngeal extending through the thyrohyoid membrane.

2:42

Now, laryn seals are,

2:44

can be due to an increase in the intraluminal pressure,

2:48

and it's typically been associated with trumpet players.

2:52

This is a famous trumpet player named Dizzy Gillespie in the United States.

2:55

You can see he's got these huge, uh, lary

2:58

Seals and part of that is dilatation of his bator muscle, but also laryn seals,

3:03

or it can be due to glass blowers because they have that increased intraluminal

3:07

pressure.

3:07

And that's what gives rise to the expansion of the

3:12

laryngeal ventricle. But even more commonly, like really I should say,

3:16

depending on where where you're located, is that,

3:19

remember the etiology of the laryngeal can be due to an obstruction right here

3:24

at the opening of the laryngeal ventricle.

3:27

And this is oftentimes due to squamous cell carcinoma.

3:30

So squamous cell carcinoma is the most common cause of an obstructive laryngeal.

3:35

And if you ever do see a a laryn seal, you should look very,

3:40

very closely at the level of the laryngeal ventricle to make sure that the cause

3:44

of the laryn seal is not due to a squamous cell carcinoma.

3:49

Now, laryn seals, uh, are typically have a, I should say,

3:53

can have different imaging appearances.

3:56

This is an example of a fluid fill laryn seal. This was another lary seal,

4:00

and if it's chronic, it can end up having high attenuation,

4:04

which is similar to what we just saw in the office hours,

4:07

if or the case that I showed you. If the lary seal becomes infected,

4:11

then you can develop a pile of lary seal in which the Lary seal basically acts

4:16

as a, an abscess, if you will. So this is an example of a lary Ringo pase seal.

4:22

Lemme just go ahead and talk about this too,

4:24

since we had the thyroid gloss of ductus realize that the thyroid gland starts

4:29

at the, uh,

4:30

apex of the circum valley papilla at frame and cecum it then,

4:35

uh,

4:35

migrates inferiorly and has this complex relationship with the hyoid bone,

4:40

and then eventually extends down to its normal resting place anterior to the

4:45

trachea. So if you have, uh,

4:48

remnants of the thyroid gland that contain fluid,

4:52

that is a thyroid gloss of duct cyst.

4:54

So you can have thyroid gloss of duct cyst here, located at the f and secum.

5:00

In this case, you can have a multiloculated cyst,

5:03

but notice how it's involving the left strap muscle.

5:06

And here's an example of a ocular thyroid gloss duct cyst involving the medial

5:11

portion of the left strap muscle.

5:15

So on rare occasions, you can have actually have, uh,

5:18

papillary thyroid cancer arising in a thyroid gloss duct cyst.

5:23

It's a rare complication, only occurs around 1%,

5:27

and the histology is usually papillary thyroid carcinoma,

5:31

followed by either mixed papillary follicular or squamous cell carcinoma.