The pyriform sinus fistula is a rare condition described as an epithelialized tract connecting the skin of the neck to the foregut, and may result in cervical cysts and iterative abscesses misleading the diagnosis. The clinical and radiological examinations are all useful. Surgery stands as one of the most effective therapeutic options consisting on the total excision on the eventual cyst, and the fistula that is followed to its inner opening on the pyriform sinus. We present a case of a 3-years-old boy with a pyriform sinus fistula that caused recurrent neck abscesses treated independently delaying the diagnosis. Once in our structure, after radiological examination and antibiotics to cool the infection down, the surgery removed the cyst with its tract that opened in the pyriform sinus. The follow up showed an effective result with the total disappearance of the lesion with no more infectious episodes. Even if it's a rare condition, the diagnosis of apyriform sinus fistula must be considered in front of every patient with a history of recurrentlatero cervical abscess.

Various pathological entities may manifest on imaging as unilateral or bilateral nasal and/or sinus opacity. The vast majority is represented by inflammatory pathologies, tumors are rare, but they are dominated mainly by benign tumors. Malignant diseases are uncommon, accounting for 3% of tumors of the head and neck. Advances in imaging using preoperative computed tomography and magnetic resonance imaging have been significantly marked in the diagnostic approach to sinonasal pathologies. Surgical modalities are influenced by preoperative knowledge of the nature and topography of the tumor. The aim of this work is to describe the clinical, radiological, and anatomopathological characteristics of sinonasal pathologies expressed by unilateral sinonasal opacity in imaging, to identify the clinicoradiological variables likely to predict malignancy, and to make a correlation between the radiological images and the anatomopathological result.