MDCT and MR Imaging Evaluation of the Laryngeal Appendix and Laryngoceles

The laryngeal appendix (saccule) is a little-discussed anatomic structure, yet associated pathologies can have severe consequences if not properly detected and treated. Extending cranially from the laryngeal ventricle, the laryngeal appendix consists of a small vertically oriented cul-de-sac centered within the supraglottic fat. Obstruction of the appendix by laryngeal pathology commonly results in dilation of this space to multiple times its native size, forming either an air or fluid-filled laryngocele. Superinfection of this isolated collection with resultant laryngopyocele formation may lead to rapid airway compromise and death if not expeditiously recognized and treated. Imaging evaluation after direct injection of the laryngeal appendix with iodinated contrast in postmortem specimens was performed to elucidate the anatomic relationship of the appendix to the surrounding laryngeal structures. MDCT and MR imaging appearances of the normal laryngeal appendix and laryngoceles will be detailed along with a pictorial review of both benign and malignant lesions resulting in laryngocele formation. Postradiation imaging of the larynx using cross-sectional techniques has become a mainstay for the evaluation of tumor recurrence in head and neck malignancies. The typical postradiation inflammatory changes involving the laryngeal appendix will be described to prevent misinterpretation of tumor recurrence.