HomePhilippine Journal of Otolaryngology Head and Neck Surgeryvol. 25 no. 2 (2010)

The Black Sombrero: A Helpful Landmark in Axial Imaging Evaluation of the Larynx and Hypopharynx

Adrian F. Fernando | Jose Florencio F. Lapena Jr. | Gil M. Maglalang

 

Abstract:

Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) evaluation of the larynx and hypopharynx can be tricky for the untrained eye. We discuss a peculiar pattern of the supraglottic airway at the level of the base of the epiglottis seen on axial CT and MR images, resembling a “black hat” or a “black sombrero.” The level of the base of the epiglottis also corresponds to that of the hyoid bone, where two valuable hypopharyngeal sub-sites are visiblethe pyriform sinuses and the posterior hypophayngeal wall.

A hat has basically two parts, an apical convex crown and a basal horizontal brim. Correlating the hat’s appearance on axial CT and MR imaging, the hat appears black due to the presence of air at the supraglottic level wherein the crown is positioned anteriorly and the brim positioned posteriorly.