Imaging Findings in Neonates With Congenital Pyriform Sinus Fistula: A Retrospective Study of 45 Cases

Abstract

Background: Congenital pyriform sinus fistula (CPSF) is a rare branchial cleft deformity. The characteristics and management of CPSF in neonates are different from those in children or adults, and a comprehensive understanding of the imaging features of neonatal CPSF can facilitate its preoperative diagnosis. Thus, the aim of this study was to summarize the ultrasonography (US) and CT imaging findings of CPSF in neonates.Methods: Forty-five full-term neonates with CPSF, confirmed by pathology after surgical resection from January 2012 to October 2020, were included in this retrospective study. All patients underwent preoperative cervical US and contrast-enhanced CT examinations, and the imaging findings were analyzed.Results: Forty-six cervical cystic masses were found in 45 neonates, including one case with bilateral lesions, three cases with lesions on the right side, and 41 cases on the left side. Both US and CT detected neck abnormality among all cases, while the diagnostic accuracy of US (15/46, 32.6%) was lower than that of CT (42/46, 91.3%). Moreover, CT showed significantly higher detection rates of intralesional air bubbles, involvement of the ipsilateral thyroid, deviation of the airway, and expansion into the mediastinal and retropharyngeal space compared with the US. As the age increased, it was more likely to present some features including the absence of air-containing, thick cyst wall, and poorly defined border (ρ <0.05).Conclusion: CPSF in the neonates showed distinctive imaging findings on contrast-enhanced CT scan, which provides important supplementary information for the diagnosis of CPSF after the initial US examination.

Clinical Features and Treatment of Congenital Pyriform Sinus Fistula: Analysis of 12 Cases

“…More specifically, the cyst walls become thicker and the cyst boundary become more blurred with age. 10 Repeated inflammation will cause adhesion with the surrounding tissue structure, and the opening of the piriform sinus to the fistula will gradually lead to inflammatory stenosis; the stenosis and closure of the adult sinus may be undetectable by B-scan ultrasonography. Enhanced CT of the neck revealed local soft tissue on the surface or uneven low-density area inside the sternocleidomastoid muscle; there is also usually no airway compression.…”

Pediatric bronchogenic cysts in the head and neck region: A study of 10 surgical cases and a review of the literature

“…The first branchial cleft anomalies (CFBCAs) often presented with repeated swelling and purulence in Pochet's triangle. CT showed round, tubular or strip-shaped abnormal the thyroid and air-containing ducts originating from the piriform fossa (23,24). It was difficult to distinguish this disease from other diseases by preoperative imaging alone (8).…”

“…The main clinical manifestations of CPSF are recurrent suppurative thyroiditis and neck abscess, predominantly located on the left sided ( 22 ). CT revealed the shallower or disappearing pyriform sinus, large cystic lesion with fluid and air, association or obscuration of the left superior thyroid lobe with the neck mass or abscess, tubular structures seen inside the thyroid and air-containing ducts originating from the piriform fossa ( 23 , 24 ).…”

A safe and effective surgical method for complex pyriform sinus fistula

“…However, for traditional endoscopy, it is difficult to expose the whole bottom of the pyriform fossa. Moreover, the fistula is usually narrow and located deep in a hidden position, which can easily lead to a missed diagnosis 37,38 . Accordingly, some scholars have proposed the modified Killian's method used for endoscopic examination, which could fully expose the pyriform fossa area and help with the diagnosis of pyriform sinus fistula 39,40 .…”

“…Moreover, the fistula is usually narrow and located deep in a hidden position, which can easily lead to a missed diagnosis. 37 , 38 Accordingly, some scholars have proposed the modified Killian's method used for endoscopic examination, which could fully expose the pyriform fossa area and help with the diagnosis of pyriform sinus fistula. 39 , 40 However, this method not only has higher requirements for the patient's body position coordination and movement coordination but also requires higher technical proficiency of the operator, which leads to certain limitations in the implementation of this method.…”