An unusual presentation of an infected vallecular cyst presenting as supraglottitis

BMJ Case Rep. 2013 Apr 22:2013:bcr2013009180. doi: 10.1136/bcr-2013-009180.

Abstract

A 50-year-old gentleman presented to the emergency department with a 24 h history of stridor, dysphonia, dysphagia and vomiting. On examination, the patient had fever and tachycardic. There was no palpable cervical lymphadenopathy. Flexible nasendoscopy and lateral neck x-ray revealed soft tissue swelling around the epiglottis. The swelling subsided with conservative management of intravenous antibiotics and steroids, only to later reveal a vallecular cyst, which was confirmed on microlaryngoscopy. The cyst was subsequently deroofed and sent for biopsy. Histological examination revealed an infected, benign vallecular cyst consisting of a squamous epithelium with underlying lymphoid tissue. In adults, vallecular cysts are usually asymptomatic, but can become infected and initiate acute supraglottitis, potentially leading to life-threatening airway obstruction. The case described here, although rare, highlights how early definitive diagnosis and management of vallecular cysts can lead to significantly improved patient outcomes.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Biopsy
  • Cysts / diagnosis*
  • Cysts / drug therapy*
  • Diagnosis, Differential
  • Drug Therapy, Combination
  • Humans
  • Laryngeal Diseases / diagnosis*
  • Laryngeal Diseases / drug therapy*
  • Laryngoscopy
  • Male
  • Middle Aged
  • Steroids / therapeutic use
  • Supraglottitis / diagnosis*
  • Supraglottitis / drug therapy*

Substances

  • Anti-Bacterial Agents
  • Steroids