Five neonatal cases of pyriform sinus fistula with cervical cystic lesion: a comparison between sonography and other modalities

Abstract

Pyriform sinus fistulas are an unusual cause of neck cystic lesions in neonates. A definitive diagnosis requires detection of the fistula, which originates from the pyriform sinus and extends to the cystic lesion. Sonography has been reported to be useful for detecting fistulas. However, there have been no reports of neonatal cases in which sonography could detect fistulas not detected by other modalities, such as barium esophagography, computed tomography (CT), or magnetic resonance imaging (MRI). We describe five neonatal patients with pyriform sinus fistula-appearing cervical cystic lesions. All patients were examined by sonography; of these, three patients were also examined by barium esophagography, two by CT, and one by MRI. The fistula was detected by sonography but not CT in one patient and by barium esophagography but not MRI in one. Two patients whose fistulas were detected by sonography had an oval-shaped and relatively small cystic lesion. One patient whose fistula could be detected only by barium esophagography had a relatively large cystic lesion. In two patients, whose fistulas were not detected by sonography or barium esophagography, sonography revealed air bubbles within the cystic lesions, and a pyriform sinus fistula was suspected. Without requiring ionizing radiation, sonography was thus useful in diagnosing pyriform sinus fistula-appearing cervical cystic lesions in neonatal cases. On the other hand, in two patients whose fistulas were not detected by sonography, the shape of the cystic lesion was polygonal or multicystic. In two of three patients with infectious signs, a fistula could not be detected. The shape and size of the cystic lesion and the presence of infectious signs may be important factors for detecting fistulas.

Congenital dermoid fistulas of the anterior chest region (CDFACR): usefulness of sonography for complete resection

“…A lateral cervical sinus, also known as a second pharyngeal or branchial cleft fistula/sinus, arises from the remnants of the second branchial cleft, and the sinus or fistula is directed toward a region between the internal and external carotid arteries [14] . A pyriform sinus fistula originates from the remnants of the fourth branchial cleft, with the fistula extending toward the pyriform sinus [15] .…”

Prenatal diagnosis and early postnatal management of pyriform sinus cyst: experience at a single medical center in mainland China

“…Ultrasonography is the first choice, but determination of the fistula demands extensive experience. The PSC fistula of a neonate is short and thin, which may not be visualized by ultrasonography all the time . MRI has the highest tissue resolution and provides more information than other imaging methods.…”

“…The PSC fistula of a neonate is short and thin, which may not be visualized by ultrasonography all the time. 13 MRI has the highest tissue resolution and provides more information than other imaging methods. When a left-sided, thick-walled cyst with typical air-fluid level is detected, the diagnosis of PSC can be made.…”

Ultrasound Evaluation of Dermal Sinuses/Fistulas in Pediatric Patients

“…As radiology is a discipline that encompasses numerous specialties; radiologists and sonographers often examine children with various diseases referred by different departments. Thus, it is important for radiologists to be familiar with the condition of a dermal sinus to be able to direct any further diagnostic imaging modality and facilitate diagnostic treatment of the condition via the appropriate specialist …”

“…In addition, color Doppler US without contrast enhancement is useful to differentiate a fistula from a vascular lumen . Determining the extent of the sinus's distal side is important for complete resection to prevent recurrence; US allows an accurate evaluation of the distal side …”