ACUTE SUPPURATIVE THYROIDITIS OR CONGENITAL
PYRIFORM SINUS FISTULA: A CASE REPORT
Valtcheva
E,
Tzaneva V
University
Hospital ¡®St. Marina¡¯, Department of Pediatrics, Varna, Bulgaria
Objective: A case of Congenital
Pyriform Sinus Fistula (CPSF) in a 6-year-old boy is reported who initially
presented with acute suppurative thyroiditis followed by one year of
clinical observation. For the first time that rare and little known
pathology has been established at the clinic during its preoperative stage.
Methods: For the purposes of
clinical observation and establishment of CPSF have been used clinical
examination, serological laboratory tests, microbiological culture tests
for oropharyngeal flora, tests for thyroid gland functioning,
ultrasonography, oesophagoscopy with barium swallow, computer tomography.
Results: For a period of one
year two recurrent episodes have been described, both on the left side of
the neck. The clinical
examination showed acute suppurative thyroiditis. Both times the onset was similar: after acute infections
of the nasopharynx accompanied by fever a painful formation was localised
on the left side of the neck that led to dysphagia and limited neck
movement. It was rapidly
reduced after antibiotic therapy.
Laboratory data demonstrated increased erythrocyte sedimentation
rate, leucocytosis, normal levels of TSH, FT4, TAT, MAT, presence of
Staphylococcus aureus. Sonography of the neck showed a low density not
clearly defined non-homogenous structure in the left lobe of the thyroid gland. During oesophagoscopy with barium
swallow, in the facing position penetration of the contrast matter is
observed distally towards the left recessus pyriformis. Immediately after the
oesophagoscopy the child took in a carbonated drink and a CT scan of the
neck was performed. A zone of
very high density (about 200 HE) was established corresponding to retained
per os contrast and followed by two air collections. We consider that particular
sequencing to be a quick and painless method for proof of CPSF.
Conclusion: In a recurrent
pathology in the left neck region with a clinical picture of acute
thyroiditis especially with a boy, the differential diagnosis should
consider CPSF. The best method
of treatment is operative resection.