Near complete dynamic/ball-valve airway obstruction by a laryngeal cyst

Excerpt

A 46-yr-old woman with a one-month history of worsening breathing difficulties presented to the emergency department after further/acute deterioration of respiratory symptoms that also included sore throat and loss of voice. On questioning, the patient (who consented to publication of this report) had not been able to breathe comfortably lying flat for more than two years. She was a ~35 pack-year smoker and, other than controlled anxiety and poor dentition, she was healthy. Her pulse oximetry on room air was 100%. Chest auscultation revealed markedly reduced air entry and inspiratory/expiratory wheezes. She presented with evident/excessive use of accessory respiratory musculature. There was no fever or leucocytosis. A chest radiograph was unremarkable. Flexible nasal pharyngo-laryngoscopy revealed a large, pedunculated laryngeal cyst originating from just below the right false vocal cord, behaving as a ball-valve in and out of the glottis during inhalation/exhalation (Figure & Electronic Supplementary Material eVideo). The vocal cords were otherwise normal.

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