Ann Pediatr Endocrinol Metab.  2014 Jun;19(2):104-107. 10.6065/apem.2014.19.2.104.

Refractory acute suppurative thyroiditis secondary to pyriform sinus fistula

Affiliations
  • 1Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Korea. yhpark@med.yu.ac.kr
  • 2Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
  • 3Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

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.

Keyword

Thyroiditis; Suppurative; Pyriform sinus; Fistula; Cautery

MeSH Terms

Anti-Bacterial Agents
Barium
Cautery
Child, Preschool
Drainage
Female
Fever
Fistula*
Humans
Laryngoscopy
Neck
Pyriform Sinus*
Rare Diseases
Thyroid Gland
Thyroiditis
Thyroiditis, Suppurative*
Trichloroacetic Acid
Anti-Bacterial Agents
Barium
Trichloroacetic Acid

Figure

  • Fig. 1 Thyroid scan shows decreased uptake of Tc-99m pertechnetate in the diffuse area of the thyroid gland.

  • Fig. 2 Ultrasonogram shows (A) enlarged thyroidi gland with diffuse heterogenous echotexture (arrow) and (B) multiple reactive lymph node enlargement.

  • Fig. 3 Computed tomography scan shows multiple hypodense abscesses in both lobes of the thyroid gland.

  • Fig. 4 Contrast was infused through an incision wound at the anterior side of the neck. There was contrast filling at the posterior pharynx, but the pathway was not compatible with a pyriform sinus fistula.

  • Fig. 5 Esophagogram was checked while swallowing contrast medium. No pyriform sinus fistula tract was demonstrated.

  • Fig. 6 Neck computed tomography scan shows air bubble superior to the left thyroid gland, which is suspicious for a fistula connected to the pyriform sinus (arrow). The scan also shows slightly decreased extent of the thyroid gland but no interval changes in the bilateral multiple enlarged lymph nodes, suggesting reactive hyperplasia.


Reference

1. Brook I. Microbiology and management of acute suppurative thyroiditis in children. Int J Pediatr Otorhinolaryngol. 2003; 67:447–451. PMID: 12697345.
Article
2. Sai Prasad TR, Chong CL, Mani A, Chui CH, Tan CE, Tee WS, et al. Acute suppurative thyroiditis in children secondary to pyriform sinus fistula. Pediatr Surg Int. 2007; 23:779–783. PMID: 17534632.
Article
3. Paes JE, Burman KD, Cohen J, Franklyn J, McHenry CR, Shoham S, et al. Acute bacterial suppurative thyroiditis: a clinical review and expert opinion. Thyroid. 2010; 20:247–255. PMID: 20144025.
Article
4. Wongphyat O, Mahachoklertwattana P, Molagool S, Poomthavorn P. Acute suppurative thyroiditis in young children. J Paediatr Child Health. 2012; 48:E116–E118. PMID: 21535286.
Article
5. Hatabu H, Kasagi K, Yamamoto K, Iida Y, Misaki T, Hidaka A, et al. Acute suppurative thyroiditis associated with piriform sinus fistula: sonographic findings. AJR Am J Roentgenol. 1990; 155:845–847. PMID: 2119120.
Article
6. Nicoucar K, Giger R, Jaecklin T, Pope HG Jr, Dulguerov P. Management of congenital third branchial arch anomalies: a systematic review. Otolaryngol Head Neck Surg. 2010; 142:21–28.e2. PMID: 20096218.
Article
7. Schneider U, Birnbacher R, Schick S, Ponhold W, Schober E. Recurrent suppurative thyroiditis due to pyriform sinus fistula: a case report. Eur J Pediatr. 1995; 154:640–642. PMID: 7588965.
Article
8. Fukata S, Miyauchi A, Kuma K, Sugawara M. Acute suppurative thyroiditis caused by an infected piriform sinus fistula with thyrotoxicosis. Thyroid. 2002; 12:175–178. PMID: 11916288.
Article
9. Yolmo D, Madana J, Kalaiarasi R, Gopalakrishnan S, Kiruba Shankar M, Krishnapriya S. Retrospective case review of pyriform sinus fistulae of third branchial arch origin commonly presenting as acute suppurative thyroiditis in children. J Laryngol Otol. 2012; 126:737–742. PMID: 22624855.
Article
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