Imaging Of Congenital Pyriform Sinus Fistula in Children

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Öztunalı Ç., Yazol M., Acu B.

XIX. Balkan Congress of Radiology (BCR), İzmir, Türkiye, 23 - 26 Ekim 2024, ss.87-89

  • Yayın Türü: Bildiri / Tam Metin Bildiri
  • Basıldığı Şehir: İzmir
  • Basıldığı Ülke: Türkiye
  • Sayfa Sayıları: ss.87-89
  • Gazi Üniversitesi Adresli: Evet

Özet

Abstract: Aim: Congenital pyriform sinus fistula (CPSF) is a rare pathology and occurs due to incomplete

obliteration of the fourth pharyngeal pouch during fetal development. The fistula causes severe recurrent neck

infections and suppurative thyroiditis in children, with or without abscess formation. This review aims to describe

and illustrate the imaging findings of CPSF in six children.Case Presentations: Ultrasonography, magnetic

resonance imaging, computed tomography, and fluoroscopy images of the neck in six children diagnosed with

CPFS are presented to illustrate the multimodality imaging findings of CP (Figures 1-3).Discussion: The CPSF

follows the proximal course of the embryologic fourth branchial pouch sinus and is mainly seen as a left-sided

sinus or fistula tract originating from the pyriform fossa, coursing posterolateral to the cricothyroid, lateral to the

thyroid lamina and the trachea. It usually ends in or around the left lobe of the thyroid gland. Esophagography

with barium or non-ionic contrast agents clearly shows the sinus tract, mainly when performed after the subsidence

of the infection. Air bubbles within the sinus tract can be best observed with CT and suggest the diagnosis. During

acute infection, CT and MRI show asymmetrical thickening and contrast enhancement of the left pyriform fossa

walls and asymmetrical thickening of the left aryepiglottic fold. US, CT, and MRI all show the sinus-related neck

infection in the course of the sinus. Suppurative thyroiditis, intrathyroidal, parathyroidal, paratracheal, or para-

laryngeal abscesses can be found. Phlegmonous infection of the deep neck spaces or the thyroid and parathyroid

tissues may mimic solid aggressive tumors of the deep neck spaces. Conclusion: CPSF is a rare and often

misdiagnosed condition in children. Knowledge of the CSSF's course and characteristic imaging findings of an

infected CPSF may help diagnose it, especially in children with a history of recurrent deep neck infections and

suppurative thyroiditis