Neck Infection Associated with Pyriform Sinus Fistula: Imaging Findings
Sun-Won Parka,
Moon Hee Hana,
Myung Hoon Sunga,
In-One Kima,
Kwang Hyun Kima,
Kee Hyun Changa and
Man Chung Hana
a From the Departments of Radiology (S-W.P., M.H.H., I-O.K., K.H.C., M.C.H.) and Otorhinolaryngology (M.H.S., K.H.K.), Seoul National University College of Medicine, Seoul, Korea.
View larger version (28K):
[in a new window]
|
FIG 1. Schematic of a surgically proved sinus tract pathway from the pyriform sinus. The sinus originated from the apex of pyriform sinus, passed through the thyroid gland, and formed an abscess in perithyroid tissue
| |
View larger version (88K):
[in a new window]
|
FIG 2. 24-year-old man with a recurrent episode of left-sided neck infection. The pyriform sinus fistula was diagnosed at hypopharyngoscopy.
A, Contrast-enhanced CT scan shows soft-tissue swelling and enhancement around the left pyriform sinus apex (thin arrows). Note the normal appearance of the right pyriform sinus apex (thick arrow).
B, CT scan shows diffuse soft-tissue swelling at the cricoid cartilage level. A small air density (arrow) is seen within the area of soft-tissue swelling.
C, CT scan at the level of the thyroid gland shows diffuse swelling of the thyroid gland and perithyroid soft tissue. The affected thyroid gland shows a poorly defined margin, hypodensity, and a focus of air (arrow).
D, Anteroposterior view from a barium swallow reveals the sinus tract (arrowheads) originating from the pyriform sinus apex and terminating in a focal collection near the left supraclavicular region.
| |
View larger version (117K):
[in a new window]
|
FIG 3. 32-year-old man with a recurrent episode of left-sided neck infection.
A, CT scan shows diffuse swelling and enhancement of the soft-tissue plane (arrows) around the left pyriform fossa.
B, Axial contrast-enhanced CT scan shows an abscess in the perithyroid tissue (arrows). Note the focus of air density in the perithyroid abscess (arrowhead).
C, Hypopharyngoscopic study reveals a sinus opening at the pyriform sinus apex (arrow) with a view from above and anterior toward the bottom. R indicates right; L, left; A, anterior; P, posterior.
| |
View larger version (150K):
[in a new window]
|
FIG 4. 9-year-old girl with recurrent episodes of left-sided neck infections. Every episode was managed with antibiotics and abscess drainage. On CT scan, the skin adjacent to the cutaneous opening is thickened and enhances (arrowheads). The pyriform sinus fistula was diagnosed at hypopharyngoscopy. The cause of the sinus tract connection to the skin surface may be either a rupture of the abscess cavity or a congenital fistulous tract, but the former is more likely
| |
View larger version (61K):
[in a new window]
|
FIG 5. 2-year-old girl with a first episode of neck abscess. The pyriform sinus fistula was diagnosed at hypopharyngoscopy.
A, Contrast-enhanced CT scan shows an abscess (arrows) in the left thyroid and perithyroid tissue.
B, T2-weighted MR image (2000/90/2 [TR/TE/excitations]) shows a collection of high signal intensity (arrows) at the same region as in A.
C, Sonogram shows a hypoechoic mass (arrows) consistent with the abscess in the left perithyroid tissue, but the sinus tract is not visible.
| |
