Acute suppurative thyroiditis (AST), a potential complication of pyriform sinus fistula (PSF), is a rare clinical condition as the thyroid gland is remarkably resistant to infections. Lack of awareness of the entity contributes to the rarity and frustrating recurrences. We performed a retrospective review of all cases of AST due to PSF treated at our institution over a 10-year period. The clinical data, investigations, operative findings and procedures, microbial culture reports and follow-up were recorded and analyzed. Between January 1997 and September 2006, 12 cases (8 males and 4 females) of AST due to PSF were treated. Nine patients (75%) underwent successful complete excision, seven of whom had initial incision and drainage procedures. In three patients (25%) with recurrence, one underwent complete excision at a later procedure, one patient had multiple recurrences with six incision and drainage procedures and two failed attempts of excision of PSF before final successful complete excision. The third patient is awaiting re-excision of the PSF tract. All patients, except the one awaiting re-excision, are well with no further recurrences during the follow-up period that ranged from 18 to 96 months (median, 46.5 months). AST due to PSF is a challenging entity in terms of diagnosis and management as recurrences are common despite meticulous dissection. High index of suspicion and radiological investigations such as barium studies and computed tomography scan aid in the delineation and excision of the fistulous tract.
"If no clinical improvement occurs after 36-48 hours of therapy, a reassessment is needed to detect the presence of abscess and PSF1,3). Also, recurrent infection of neck or thyroid gland, especially left sided, evaluation for underlying anomaly such as PSF should be done2,9). Treatment of choice for PSF is elective excision. "
[Show abstract][Hide abstract] ABSTRACT: Acute suppurative thyroiditis is a rare disease because the thyroid gland is remarkably resistant to infection. We present a 2-year-old girl with refractory acute suppurative thyroiditis due to a pyriform sinus fistula (PSF). She complained of fever and painful anterior neck swelling. Her condition did not completely improved by multiple parenteral antibiotics along with incision and drainage. Barium esophagogram to detect PSF demonstrated no specific finding. Computed tomography scan showed air bubble superior to the left thyroid gland which indicated a possible fistula connected to the pyriform sinus. An intraoperative laryngoscopy revealed a 2-mm-sized fistula opening. The fistula was successfully treated by chemocauterization with trichloroacetic acid.
[Show abstract][Hide abstract] ABSTRACT: Children frequently present with a neck mass and imaging plays an important role in their diagnosis and subsequent management. High-resolution ultrasound is the ideal initial imaging modality of choice as diagnosis can be made in most cases, and cross-sectional imaging such as magnetic resonance imaging and computed tomography serve a supplementary role. This review aims to familiarise paediatricians and radiologists with imaging features of common non-nodal neck masses in children.
[Show abstract][Hide abstract] ABSTRACT: Atypical Form of Acute Suppurative Thyroiditis in Pediatric Patient: Case Report. Acute thyroiditis is an unusual disease. In pediatric patients it is usually as- sociated with congenital abnormalities towards the unilateral envelopment of the left thyroid lobe. In general, in the absence of preexisting thyroid disease, the thyroid function is most often normal. It is here described a case of a six- year-old girl who had presented a mass with flogistic signs in the anterior neck region for fifteen days, together with leukocytosis and increased levels of VSH and TSH. There was no evidence of previous thyroid disease and the cervical ultrasonography suggested thyroid abscess. Intravenous antibiotic and surgical dranaige were done with a good response, however, the patient developed clinical hypothyroidism aftherwards . Barium swallow did not demonstrate pyriform sinus fistula and the follow-up ultrasonography re- vealed heterogeneous internal texture suggesting Hashimotos Thyroiditis. The relevance of this case is due to its unusual findings: the absence of con- genital abnormalities, bilateral envelopment of thyroid lobes, hypothyroid- ism and a probable Hashimotos Thyroiditis as a predisposing factor for acute thyroiditis. Arq Bras Endocrinol Metab 2008; 52/4:701-706)
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