1/18. Acute suppurative thyroiditis caused by an infected piriform sinus fistula with thyrotoxicosis.We report herein an unusual case of thyrotoxicosis caused by acute suppurative thyroiditis (AST) infected through a piriform sinus fistula (PSF). A 28-year-old man presented with pain over the thyroid gland and elevated serum thyroid hormone levels, a picture similar to subacute thyroiditis. A fine-needle aspiration biopsy from the left lobe showed neutrophil infiltration, and culture from the aspirate grew anaerobic peptostreptococcus. A neck computed tomography (CT) scan showed an abscess in the thyroid gland, and barium swallow revealed the presence of PSF. Appropriate antibiotic treatment ameliorated his symptoms of infection, followed by normalization of thyroid function. Three months later, he underwent fistulectomy and partial left lobectomy. The end of the PSF track was found in the left thyroid lobe. Thus infection of the thyroid gland through the infected PSF was likely the cause of supprative thyroiditis. The unusual clinical features of AST in this patient include the presence of severe thyrotoxicosis, relatively late onset (28-years-old) of infection despite the presence of congenital PSF, and the lack of acute inflammatory signs on the overlying skin of the thyroid gland. It is important to recognize this type of AST, since fistulectomy is required to prevent recurrent AST.- - - - - - - - - - ranking = 1keywords = thyroiditis (Clic here for more details about this article) |
2/18. Congenital fistula of the apex of the pyriform sinus: an overlooked phenomenon of debatable origin.fistula of the pyriform sinus apex is an often overlooked entity which generally manifests itself as acute suppurative thyroiditis or recurrent deep neck abscesses in children or young adults. Two cases are reported. Arguments in favor of a fourth pharyngeal pouch origin are stressed and the surgical management is described.- - - - - - - - - - ranking = 0.14285714285714keywords = thyroiditis (Clic here for more details about this article) |
3/18. Endoscopic fibrin sealing of congenital pyriform sinus fistula.pyriform sinus fistula is a very rare branchial apparatus malformation, often appearing in the form of a cervical inflammatory process (abscess or suppurative thyroiditis), especially in infants. Failure to diagnose this lesion may result in unexpected recurrence. A case of recurrent suppurative thyroiditis caused by pyriform sinus fistula in a 9-year-old girl is reported. In the latency period of infection, the fistula tract was identified by a barium meal contrast study. Direct endoscopy showed the fistula internal orifice at the apex of the left pyriform fossa. The fistula was completely obliterated by injection of fibrin glue. Suppurative thyroiditis is reported mainly in the pediatric literature, and the reported case is the first to be managed endoscopically by injection of fibrin adhesive.- - - - - - - - - - ranking = 0.42857142857143keywords = thyroiditis (Clic here for more details about this article) |
4/18. Acute suppurative thyroiditis with bilateral piriform sinus fistulae.Although there are many possible routes of infection in AST, the clinician must be aware of a possible fistula between the piriform sinus and the perithyroidal space--especially in patients with recurrent episodes of AST. diagnosis of this congenital tract requires a high index of suspicion and radiographic demonstration by a barium swallow or endoscopic visualization. Effective treatment of AST with intravenous antibiotics and appropriate surgical intervention have greatly reduced the mortality and secondary complications. Complete fistulectomy, however, is required for permanent cure.- - - - - - - - - - ranking = 0.57142857142857keywords = thyroiditis (Clic here for more details about this article) |
5/18. Acute suppurative thyroiditis and the branchial apparatus.Acute suppurative thyroiditis and thyroid abscess are rare. The finding of a sinus tract arising from the pyriform sinus in some cases highlights the possibility of a branchial apparatus origin. We present three case histories that include a left-sided lesion and radiologic or surgical-anatomic evidence of an internal sinus tract. Our discussion focuses on two considerations: first, the exact branchial pouch from which this lesion arises, and second, a proposed protocol for the work-up and management of patients with the onset or recurrence of acute suppurative thyroiditis or thyroid abscess.- - - - - - - - - - ranking = 0.85714285714286keywords = thyroiditis (Clic here for more details about this article) |
6/18. Congenital pyriform sinus fistula: a cause of acute left-sided suppurative thyroiditis and neck abscess in children.Acute bacterial thyroiditis or neck abscesses in children can be caused by infection through pyriform sinus fistulae which usually originate from the tip of the left pyriform sinus. They are thought to be remnants of either the third or fourth pharyngeal pouches. CT, ultrasound and gastrointestinal contrast studies are all useful in clarifying the pathological process and showing the extent.- - - - - - - - - - ranking = 0.71428571428571keywords = thyroiditis (Clic here for more details about this article) |
7/18. Acute suppurative thyroiditis in appearance of unusual neck mass.We report on three adult cases of acute suppurative thyroiditis due to infection through a piriform sinus fistula. In these cases, the lesion did not exhibit the clinical symptoms characteristic of acute suppuration, but appeared as an unusual neck mass. Repeated barium meal roentgenograms, however, demonstrated the internal fistula in two of the three cases. Acute suppurative thyroiditis may not be so rare even in adults. When acute suppurative thyroiditis occurs in adults with scanty symptoms of acute suppuration, the piriform sinus fistula could easily go undetected. Recognition of acute suppurative thyroiditis in adults per se seems to be important for correct diagnosis.- - - - - - - - - - ranking = 1.1428571428571keywords = thyroiditis (Clic here for more details about this article) |
8/18. pyriform sinus fistula: an unusual cause of recurrent retropharyngeal abscess and cellulitis.Recurrent retropharyngeal cellulitis and recurrent suppurative thyroiditis are rare entities that share a common cause. A congenital fistula from the pyriform sinus apex to the thyroid gland has been identified in approximately 23 cases of suppurative thyroiditis and now has been implicated in a case of retropharyngeal abscess and repeated episodes of cellulitis. Virtually all reported cases have been on the left side, and the fistula is usually identified with a barium swallow study. When the esophagogram fails to demonstrate a fistula, a careful endoscopic search in the area of the left pyriform sinus should be actively pursued. An external surgical approach, which includes resection of the entire tract and involved area of the left thyroid, has been curative in all reported cases subjected to definitive surgical exploration.- - - - - - - - - - ranking = 0.28571428571429keywords = thyroiditis (Clic here for more details about this article) |
9/18. Piriform sinus fistula as a route of infection in acute suppurative thyroiditis.A case of acute suppurative thyroiditis due to a left piriform sinus fistula was reported. A five-year old boy had a acutely painful tumor in the anterior part of the neck. It was a diffuse, firm, warm erythematous tumor, and laboratory, radiologic findings showed the acute inflammation of the left lobe of thyroid. a barium swallow revealed a very thin fistula originating from the apex of the left piriform sinus extending antero-inferiorly. This fistula was considered to be a route of infection in acute suppurative thyroiditis, allowing bacterial infection to begin in the perithyroidal space and spread to the thyroid gland. The complete fistulectomy was required for a permanent cure, but an administration of antibiotics was very effective in this case.- - - - - - - - - - ranking = 0.85714285714286keywords = thyroiditis (Clic here for more details about this article) |
10/18. The diagnosis and management of pyriform sinus fistulae in infants and young children.Acute suppurative thyroiditis is rare in childhood. It presented in two clinically euthyroid children over a 2-year period. Repeated drainage for recurrent abscesses was necessary in one child. thyroiditis without abscess was present in the second. After treatment and resolution of the infection, contrast studies with barium demonstrated an internal fistula extending from the left pyriform sinus to the ipsilateral thyroid lobe. Thyroid scans showed decreased uptake in the left lobe. Thyroid-function tests were normal. A third infant developed acute respiratory distress at 2 weeks of age from an enlarging left neck mass without evidence of infection. Exploration revealed an intrathyroid cyst with fistulous communication to the left pyriform sinus. Fistulas arise from the third pharyngeal pouch as a branchial remnant which is exclusively left-sided. Administration of antibiotics, which are effective against oral flora, combined with initial drainage of suppuration control infection. Only then can the diagnosis be made by contrast study of the hypopharynx and upper esophagus. Operative excision of the entire epithelial tract and adjacent thyroid tissue is essential to prevent recurrent thyroiditis and abscess.- - - - - - - - - - ranking = 0.28571428571429keywords = thyroiditis (Clic here for more details about this article) |
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