Air-Containing Lesions in Neck

Bernadette L. Koch, MD

DIFFERENTIAL DIAGNOSIS

Common

Less Common

Rare but Important

ESSENTIAL INFORMATION

Helpful Clues for Common Diagnoses

General Trauma
- Key facts: Esophageal, pharyngeal, laryngeal, or superficial trauma
- Imaging: Extraluminal air in neck ± laryngeal, hyoid, or facial fractures
Retropharyngeal Space (RPS) Abscess
- Key facts: Posterior to pharyngeal mucosal space, anterior to prevertebral space
- Imaging: Extranodal purulent fluid in RPS ± air in or adjacent to fluid collection ± extension to mediastinum

Helpful Clues for Less Common Diagnoses

Laryngocele
- Key facts: Lateral saccular cyst, laryngeal mucocele
- Imaging: Air ± air-filled level
  - Internal laryngocele in paraglottic space
  - Mixed laryngocele in paraglottic and submandibular spaces
Esophago-Pharyngeal Diverticulum
- Key facts: Zenker diverticulum = mucosal-lined outpouching of posterior hypopharynx
- Imaging: Air-filled pouch posterior; usually extends left of esophagus

Helpful Clues for Rare Diagnoses

4th Branchial Anomaly
- Key facts: 4th pharyngeal pouch remnant
  - Extends from apex of pyriform sinus to lower neck, anterior to left thyroid lobe
  - Present with recurrent thyroiditis or anterior neck abscess
- Imaging
  - Abscess anterior to left thyroid lobe ± intrinsic inflammatory change in ipsilateral thyroid lobe
  - Inflamed pyriform sinus apex
  - Lack of aeration of pyriform sinus apex
Lateral Cervical Esophageal Diverticulum
- Key facts: Mucosal-lined outpouching lateral to cervical esophagus
- Imaging: Air-filled pouch lateral to cervical esophagus
Spontaneous Cervical Emphysema
- Key facts: No history of vomiting, trauma, asthma, or other inciting event
- Imaging: Pneumomediastinum and cervical emphysema