Skip to main content
SpringerLink
Log in

Imaging studies of pyriform sinus fistula

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Pyriform sinus fistula (PSF) refers to a persistent embryologic third or fourth pharyngeal pouch, which typically presents as a congenital sinus tract that originates from the pyriform sinus. The sinus tract is often diagnosed by a barium study or direct endoscopic inspection. Utilization of advanced imaging studies, including ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), may aid in the diagnosis of this disease entity.

Objectives

To review the imaging findings of PSF and demonstrate the value of various cross-sectional imaging (US, CT, and MRI) in the diagnosis of PSF.

Materials and methods

PSF in five children was verified surgically. Preoperative barium esophagography, US, CT, and MRI were performed selectively in these patients. The clinical and imaging findings are reviewed retrospectively.

Results

Barium studies demonstrated the sinus tract in all five patients. US, CT, and MRI demonstrated an associated inflammatory process. By utilizing the trumpet maneuver, the presence of sinus tract was evident in two patients during US. The sinus tract is also demonstrated by CT in another patient.

Conclusions

Although barium esophagography is advantageous in demonstration of the sinus tract in PSF, US and CT are also capable of showing the sinus tract. The extent of inflammatory process related to PSF is better delineated by US, CT, and MRI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.
Fig. 3a–c.
Fig. 4a, b.
Fig. 5.
Fig. 6.
Fig. 7.
Fig. 8.
Fig. 9.

Similar content being viewed by others

References

  1. Nicollas R, Ducroz V, Garabedian EN, et al (1998) Fourth branchial pouch anomalies: a study of six cases and review of the literature. Int J Otorhinolaryngol 44:5–10

    Article  CAS  Google Scholar 

  2. Herman TE, McAlister WH, Siegel MJ (1992) Branchial fistula: CT manifestations. Pediatr Radiol 22:152–153

    CAS  PubMed  Google Scholar 

  3. Benson MT, Dalen K, Mancuso AA, et al (1992) Congenital anomalies of the branchial apparatus: embryology and pathologic anatomy. Radiographics 12:943–960

    CAS  PubMed  Google Scholar 

  4. Burge D, Middleton A (1983) Persistent pharyngeal pouch derivatives in the neonate. J Pediatr Surg 18:230–234

    CAS  PubMed  Google Scholar 

  5. Chin AC, Radhakrishnan J, Slatton D, et al (2000) Congenital cysts of the third and fourth pharyngeal pouches or pyriform sinus cysts. J Pediatr Surg 35:1252–1255

    Article  CAS  PubMed  Google Scholar 

  6. Park SW, Han MH, Sung MH, et al (2000) Neck infection associated with pyriform sinus fistula: imaging findings. AJNR 21:817–822

    CAS  PubMed  Google Scholar 

  7. Har-El G, Sasaki CT, Prager D, et al (1991) Acute suppurative thyroiditis and the branchial apparatus. Am J Otolaryngiol 12:6–11

    CAS  Google Scholar 

  8. Babbitt DP, Glicklich M (1970) Barium swallowing aids diagnosis of recurrent neck abscess. Medical Tribune-World Wide Report 54:Oct 26

    Google Scholar 

  9. Lucaya J, Berdon WE, Enriquez G, et al (1990) Congenital pyriform sinus fistula: a cause of acute left-sided suppurative thyroiditis and neck abscess in children. Pediatr Radiol 21:27–29

    CAS  PubMed  Google Scholar 

  10. Hatabu H, Kasagi K, Yamamoto K, et al (1990) Acute suppurative thyroiditis associated with piriform sinus fistula: sonographic findings. AJR 155:845–847

    CAS  Google Scholar 

  11. Schneider U, Birnbacher R, Schick S, et al (1995) Recurrent suppurative thyroiditis due to pyriform sinus fistula: a case report. Eur J Pediatr 154:640–642

    Article  CAS  PubMed  Google Scholar 

  12. Bar-Ziv J, Slasky BS, Sichel JY, et al (1996) Branchial pouch sinus tract from the piriform fossa causing acute suppurative thyroiditis, neck abscess, or both: CT appearance and the use of air as a contrast agent. AJR 167:1569–1572

    CAS  Google Scholar 

  13. Hillel AD, Schwartz AN (1989) Trumpet maneuver for visual and CT examination of the pyriform sinus and retrocricoid area. Head Neck 11:231–236

    CAS  PubMed  Google Scholar 

  14. Price DB, Miller LJ, Price AP (1993) Evaluation of nondistended pyriform sinus without respiratory maneuvers. J Comput Assist Tomogr 17:163–165

    CAS  PubMed  Google Scholar 

  15. Rubesin SE, Jones B, Donner MW (1987) Contrast pharyngography: the importance of phonation. AJR 148:269–272

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Rd., Taipei, Taiwan 11217, Republic of China

    Hsin-Kai Wang, Chui-Mei Tiu, Yi-Hong Chou & Cheng-Yen Chang

Authors
  1. Hsin-Kai Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chui-Mei Tiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yi-Hong Chou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cheng-Yen Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chui-Mei Tiu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wang, HK., Tiu, CM., Chou, YH. et al. Imaging studies of pyriform sinus fistula. Ped Radiol 33, 328–333 (2003). https://doi.org/10.1007/s00247-003-0887-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-003-0887-8

Keywords

Search

Navigation