A fatal case of severe neck abscess due to a third branchial cleft fistula: morphologic and immunohistochemical analyses

Abstract

BackgroundBranchial cleft anomalies constitute a frequently encountered and commonly non-lethal disease in otolaryngology, and result from aberrant embryonic development. The third branchial cleft fistula is one of the four known specific types of branchial cleft anomalies, and always presents as recurrent neck abscess and suppurative thyroiditis. Here, we report an unexpected death due to severe neck infection following a third branchial cleft fistula.Case presentationA 19-year-old man was sent to the hospital with a 1-week history of recurrent left-sided neck abscess, and was scheduled for incision and drainage of the abscess. However, before the surgery was performed, the man’s condition deteriorated and he died. A review of his medical history showed that he had undergone a previous incision and drainage for a neck abscess 2 years ago. Postmortem examination revealed that the fatal neck abscess was induced by a third branchial cleft fistula.ConclusionsWe conclude that a histopathological examination of neck tissue combined with a detailed review of medical history and examination of ultrasonographic and CT images can provide a rapid and accurate diagnosis of third branchial cleft fistula. This common, non-lethal disease can potentially lead to death if the neck infection is not properly diagnosed and treated. In medico-legal practice, medical examiners should be aware of this condition, as this knowledge would be important in the diagnosis of the cause of death.

MRI in Children With Pyriform Sinus Fistula

“…[2][3][4]6 Although this sinus is proposed to follow a two-loop course, case reports matching these descriptions are rare, and the most common location of clinical infection is the descending part of this tract before the first loop. 2,6 Due to a low incidence, many patients receive a delayed diagnosis, which results in life-threatening complications [7][8][9][10] and delayed treatment.…”

Endoscopic Management of Recurrent Third Branchial Fistula using Histoacryl Glue

“…Third and fourth branchial abnormalities are rare accounting for 2-8% and 1-4% respectively. [1,2] Classically, the origin of these fistulae is a result of persistence of the pharyngobranchial duct which connects the third and fourth pharyngeal pouches to the pharynx and normally degenerates during the 7th week of embryonic development. [3]Our patient presented with history of recurrent left sided neck abscess and discharge since childhood.…”

“…Branchial cleft fistula occur as a result of abnormal embryonic development of the branchial apparatus resulting in congenital anomalies of the head and neck. [1] There is a lack of general consensus on the management of third and fourth branchial anomalies. [2] Traditionally, surgical fistulectomy has been the treatment of choice.…”

Methicillin-Sensitive Staphylococcus aureus Suppurative Thyroiditis with Thyrotoxicosis

“…While AST is a rare condition, it is important to recognize it as it can be fatal, with some estimating a 12% or higher mortality rate [ 3 ]. Fatal case reports have shown rupture of AST causing airway complication [ 8 ] leading to significant morbidity. Other complications of AST include vocal cord paralysis and permanent damage to the thyroid gland causing chronic hypothyroidism [ 3 ].…”