The differential diagnosis of a paratracheal air collection includes pharyngocele
, esophageal diverticulum, laryngocele, apical lung hernia, and apical paraseptal blebs, or bullae.
On flexible laryngoscopy, a small left pharyngocele was seen at the thyrohyoid membrane just above the thyroid cartilage and piriform fossa (figure, A).
Several options were discussed with the patient, including observation, swallowing therapy, percutaneous augmentation of the pharyngocele, and open surgical excision.
Pharyngocele, or lateral pharyngeal diverticulum (LPD), is rare, as only a few cases have been described.
1,2) The first well-documented case of a pharyngocele was reported by Wheeler (3) in 1886, and the first roentgenographic study of a pharyngocele was published by Hankins (4) in 1944.
Differentiating a pharyngocele from a laryngocele can be difficult given that both entities appear clinically in a similar manner.
When the ostium of a pharyngocele is located in this area, it is usually situated on the internal surface of the pharynx, in the region inferior to the lower pole of the tonsil and at the lateral side of the vallecula.
Ward, and in our paper) of laryngocele and pharyngocele remain valid, combinations of both can occur.
Laryngoceles in general do require surgery, while pharyngoceles are not true pouches and diminish in size if the increases in pharyngeal pressure (playing a musical instrument) are stopped.
In our review of the medical literature, we found a number of case reports with unusual presentations of BAs, including retropharyngeal abscesses, (2,3) pharyngoceles, (4) duplicate ossicles, (5) intrathryoidal lesions, (6-8) an epiglottic cyst, (9) and 2 cases of pharyngeal branchial cysts involving the tonsil.
Several unusual BAs have been reported, including retropharyngeal abscesses, (2,3,20) pharyngoceles, (4) duplicate middle ear ossicles, (5) and intrathyroidal masses and abscesses.
In a LETTER TO THE EDITOR in the March issue of EAR, NOSE, AND THROAT JOURNAL, a comment was made regarding the differentiation between laryngoceles and pharyngoceles