Imaging Of a Rare Case of Vallecular Cyst Presenting with Odynophagia: A Case Report

Background: Vallecular cysts are very rare benign ductal cysts in the larynx. While many remain asymptomatic, symptomatic patients may present with airway obstruction, respiratory distress or odynophagia. In this article, the patient exhibits a vallecular cyst accompanied by odynophagia and hemoptysis- symptoms not commonly associated with these cysts. Flexible laryngoscopy and radiologic imaging are pivotal in the diagnosis of vallecular cysts, aiding in the assessment of their size, location, and relationship to surrounding structures, which are essential for effective surgical planning. Given the limited number of cases reporting vallecular cysts with odynophagia, and hemoptysis being described in only two cases in the literature, this article aims to provide a comprehensive approach to the diagnosis and management of vallecular cysts presenting with these rare and concerning symptoms- odynophagia and hemoptysis. Case presentation: A 44-year-old Indian gentleman presented to the ENT (Ear, Nose, Throat) Department with history of hemoptysis for the past 4 days with history of painful swallowing for the past 1 month, recurrent upper respiratory tract infections and 1.25 pack years of smoking history. On examination, bilateral non-tender neck nodes were palpable. The patient was referred to the Radiology Department for Contrast-Enhanced Computed Tomography (CECT) of the neck, which revealed two well-defined oval lesions with the right sided lesion becoming completely hyperdense, averaging ~ 40-50 HU (Hounsfield Unit) and the lesion on the left side showing central hypodensity, averaging ~ 10 to 12 HU (Hounsfield Unit) of water, suspicious area of enhancement was also seen involving the vallecula, extending to supraglottis, in close proximity to bilateral pyriform fossa- A possibility of bilateral vallecular cysts with bleed in the right cyst was considered. The patient was subjected to a video laryngoscopy examination that confirmed bilateral vallecular cysts with the right cyst showing granulations on its surface along with the presence of clots. The patient was planned for excision of the right vallecular cyst. Postoperative recovery was favorable with satisfactory wound healing observed on a 2-week follow-up video laryngoscopy. Conclusion: Vallecular cysts are rare, benign lesions in the supraglottic region of the larynx, resulting from the obstruction of mucous glands. While majority of vallecular cysts remain asymptomatic, some can present with atypical symptoms like foreign body sensation, odynophagia, hoarseness, stridor, cough, hemoptysis and dysphonia. These symptoms can mimic more serious conditions such as tumors or foreign body aspiration, necessitating the use of precise imaging techniques for accurate diagnosis and surgical planning. Surgical excision remains the cornerstone of management for symptomatic patients and large vallecular cysts.