Calcification of the epiglottis

Clinical History

A 67-year-old male underwent CT examination of the neck for preoperative mapping of a thyroid goitre. His symptoms were of intermittent voice loss.
Medical history: No hypertension. Osteoarthritis. Recurrent renal colic. No granulomatous disease or previous radiotherapy. Surgical history: Mechanical aortic prosthesis; left inguinal hernia.

Imaging Findings

CT was performed to look for intrathoracic extension of the patients' goitre.

As an incidental finding, partial calcification of the epiglottis was noted involving the lower two-thirds of this structure (the free portion shows no calcification).

Discussion

Calcification of laryngeal cartilages is described in numerous anatomy texts which usually state that the epiglottis, cuneiform and corniculate cartilages almost never calcify, due to their elastic properties [1, 2]. This rare and interesting case demonstrates epiglottic cartilage calcification with no known underlying cause. Previous literature has reported cases of calcification secondary to treatment with radiotherapy or in patients with granulomatous disease [2, 3].

There are three unpaired (thyroid, epiglottis and cricoid) and three paired (arytenoid, cuneiform and corniculate) laryngeal cartilages. The epiglottis and the cartilages of Wrisberg (such as the cuneiform and the corniculate cartilages) are made of yellow elastic fibro cartilage and may calcify with age [2,3]. Most of the consulted sources indicate that the epiglottic cartilage does not calcify, however some state that it does [5].

During swallowing, the epiglottis works to protect the entrance of the airway, acting as a cover across the laryngeal inlet. Calcification could alter its mechanical properties and favour aspiration leading to a significant risk of pneumonia in the elderly [2]. Furthermore, the presence of lesions (such as a Zenker diverticulum) can cause a weak peristaltic wave leading to hypomotility of the epiglottis which may predispose it to calcify [4].

Concerning treatment, this kind of calcification does not require any unless there are respiratory complications [4].

Differential Diagnosis List

Final Diagnosis

Diffuse calcification of the epiglottis.

URL:	https://eurorad.org/case/14352
DOI:	10.1594/EURORAD/CASE.14352
ISSN:	1563-4086