Submucosal laryngeal lesions: A puzzling diagnostic conundrum

Laryngeal mucosal masses are commonly squamous cell carcinomas, easily identified and biopsied on scope. In contrast, a submucosal laryngeal mass has a broad differential diagnosis, including benign and malignant epithelial and non-epithelial neoplasms as well as other non-neoplastic abnormalities including vascular malformations, infective or inflammatory pathologies, submucosal hematoma, rare depositional diseases such as amyloidosis, and other benign lesions such as laryngoceles. Due to a lack of visible mucosal abnormality, biopsy of these lesions are often challenging with higher rates of false negatives or inadequate sampling. Whilst radiological imaging features of submucosal laryngeal lesions may be non-specific, there are some lesions which may exhibit typical imaging features which could help radiologists to narrow the differential diagnosis and direct diagnostic workup and clinical management more effectively. In this article, we will illustrate a spectrum of submucosal laryngeal lesions, with an emphasis on helpful imaging features to help distinguish pathologies, and an overview of appropriate workup and management aspects which the radiologist needs to know to contribute effectively to patient care.