Left cervical abscess due to a pyriform sinus fistula in a 3-year-old girl successfully diagnosed by pharyngoesophagography
Year: 2011
Type: article
Study design: Case Report
Abstract: A 3-year-old girl with a left cervical mass was admitted to our hospital. A firm, immobile left cervical mass was palpable. Computed tomography and magnetic resonance imaging revealed a lesion extending mainly from the left carotid space to the left lobe of the thyroid gland. As malignancy could not be excluded, we performed an open biopsy. During the biopsy, a small amount of pus outflowed from the mass; Streptococcus parasanguis, a normal oral flora, was isolated by culturing the pus. A histopathological study revealed chronic inflammation, with scattered acute inflammatory processes. Since the abscess was on the left side and a normal oral flora was thought to be the pathogen responsible, pyriform sinus fistula was suspected. Although pharyngoesophagography is stated to be useful for diagnosing pyriform sinus fistulas, it was hard to perform in the present case because of the patient's fear and anxiety. Because grape juice was her favorite, we prepared a contrast material consisting of equal parts of grape juice and barium sulfate. A carton of this juice was employed as a container and a blinder for the contrast material. By drinking the contrast material with grape flavor through a straw inserted to the carton as usual, she might feel less fear and anxiety, resulting in successful pharyngoesophagographywith sufficient cooperation. Although pharyngoesophagography did not reveal a fistula tract, she was treated by incision with drainage and antibiotics and was then discharged. Pharyngoesophagography was repeated 3 months after discharge and revealed a left pyriform sinus fistula. We reviewed published pediatric cases; the relative ineffectiveness of pharyngoesophagography in preschool children was demonstrated. Their poor cooperation was thought to impair its usefulness. Our case suggests that devising a patient-friendly method can alleviate the difficulty in performing pharyngoesophagography and lead to successful diagnosis of pyriform sinus fistulas, even in preschool children.
Source: Tenri Medical Bulletin
Institution: Tenri Hospital
Language: English
Topic: Head and Neck Anomalies
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4230010403