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Misdiagnosis of asymptomatic intrathyroidal pyriform sinus fistula: a case report.

ABSTRACT: Pyriform sinus fistula is uncommon and easily misdiagnosed. Most reported cases occur in children and are associated with either acute suppurative thyroiditis or deep neck infection. Asymptomatic pyriform sinus fistula is difficult to diagnose because it can manifest as an incidental thyroid nodule with highly suspicious malignant features on ultrasonography. The patient was a 41-year-old man with asymptomatic thyroid nodules incidentally detected on ultrasonography. Surgery was performed under the suspicion of thyroid cancer. Pathology findings revealed multiple cystic walls lined by ciliated columnar cells with stratified squamous epithelial cysts in a background of inflammatory and lymphoid cells. Barium swallow examination performed 2 weeks later revealed a sinus tract measuring 1.8 cm that arose from the apex of the left pyriform sinus. The diagnosis and management of pyriform sinus anomalies are challenging. The majority of physicians, including some otolaryngologists, lack an understanding of the disease, which should be considered one of the important differential diagnoses of neck masses. Barium swallow examination, ultrasonography, computed tomography, and laryngoscopy are useful to diagnose this condition.

SUBMITTER: Hao Z

PROVIDER: S-EPMC8295969 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Misdiagnosed pyriform sinus fistula revealed by iterative neck abscesses: A case report and review of the literature.

Project description:The pyriform sinus fistula is a rare condition described as an epithelialized tract connecting the skin of the neck to the foregut, and may result in cervical cysts and iterative abscesses misleading the diagnosis. The clinical and radiological examinations are all useful. Surgery stands as one of the most effective therapeutic options consisting on the total excision on the eventual cyst, and the fistula that is followed to its inner opening on the pyriform sinus. We present a case of a 3-years-old boy with a pyriform sinus fistula that caused recurrent neck abscesses treated independently delaying the diagnosis. Once in our structure, after radiological examination and antibiotics to cool the infection down, the surgery removed the cyst with its tract that opened in the pyriform sinus. The follow up showed an effective result with the total disappearance of the lesion with no more infectious episodes. Even if it's a rare condition, the diagnosis of apyriform sinus fistula must be considered in front of every patient with a history of recurrentlatero cervical abscess.

| S-EPMC7501404 | biostudies-literature

A safe and effective surgical method for complex pyriform sinus fistula.

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| S-EPMC9764781 | biostudies-literature

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| S-EPMC4186215 | biostudies-literature

Intrathyroidal parathyroid carcinoma presenting as thyroid nodule: Case report of unusual location.

Project description:IntroductionParathyroid carcinoma (PC) is considered a rare and uncommon malignancy. Its prevalence is about 0.005% of all cancers. Intrathyroidal location is rare, rendering preoperative diagnosis tedious. Until now, around 700 cases of PC have been documented, reportedly, among them, less than 21 cases of intrathyroidal parathyroid carcinoma have been described in the literature. We report a case of intrathyroidal PC that was taken for a suspicious thyroid nodule, with a literature review.PRESENTATION OF THE CASE: Our case is an asymptomatic intrathyroidal PC imitating a suspicious thyroid nodule, in a 54-year-old woman. A literature review was performed about clinical, radiological features, histopathological findings, and therapeutic options.DiscussionThe diagnosis of asymptomatic intrathyroidal parathyroid carcinoma, similar to our case report, is even more difficult, our patient had no symptoms of hypercalcemia. Surgery is the cornerstone of the treatment. A better chance to cure this disease is conditioned by complete surgical resection with negative margins microscopically, that was the case of our patient with a very good clinical course after 12 months of follow-up.

| S-EPMC9289316 | biostudies-literature

Superior sagittal sinus dural arteriovenous fistula with changes in angiographic findings associated with contiguous parasagittal meningioma: A case report.

Project description:BackgroundMeningioma and dural arteriovenous fistula (dAVF) located at the same site are rare. The present case demonstrated the transformation of tumor feeding vessels into the pial feeder of the dAVF over time, which may help to elucidate the pathogenesis of tumor-associated dAVF.Case descriptionA 71-year-old man presented with convulsion. Magnetic resonance (MR) imaging showed a right parasagittal sinus meningioma invading the superior sagittal sinus (SSS). Bilateral external carotid angiography showed dAVF at the SSS, near the site of tumor invasion. The right internal carotid angiography showed tumor staining from the anterior cerebral artery with intra-tumor arteriovenous shunting, with stagnation of tumor blood flow, suggesting impairment of perfusion to the SSS. Four years after the initial diagnosis, the patient was admitted to hospital with status epilepticus, and MR imaging showed an enlarged tumor. Carotid angiography revealed transformation of the tumor feeders to the pial feeder of the dAVF. The findings of shunting to the SSS had intensified, and stenosis had occurred in the posterior third of the SSS. The venous return showed retrograde flow anteriorly to the SSS. The patient underwent endovascular embolization and tumor resection. The shunt had disappeared.ConclusionThis report supports the proposal that impaired venous return is an important factor in the shunt occurrence of dAVF. Neurosurgeons should consider that cases of meningioma invading the venous sinuses may be complicated by dAVF and changes may occur over time.

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A case report of a young woman with pulmonary emboli and a right coronary artery-to-coronary sinus fistula.

Project description:BackgroundCoronary artery fistulae are rare cardiovascular anomalies that can present with atypical symptomatology and therefore pose diagnostic challenges, especially in young patients.Case summaryA 34-year-old woman presented with left-sided pleuritic chest pain, haemoptysis, and flu-like symptoms. Initial evaluation revealed multiple left-sided pulmonary emboli, and her transthoracic echocardiography showed turbulent flow in a dilated coronary sinus. A right coronary artery (RCA) to coronary sinus fistula was confirmed by computed tomography coronary angiogram. The patient was treated with lifelong anticoagulation, and a subsequent stress cardiac magnetic resonance imaging did not show inducible myocardial ischaemia. As such, the patient was managed conservatively.DiscussionUtilization of multi-modality imaging is of utmost importance for diagnostic and therapeutic purposes in coronary artery fistulae. In this case report, our patient presented with unprovoked pulmonary emboli, which could be caused by the turbulent flow and stasis, due to the RCA-to-coronary sinus fistula.

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Acquired aortopulmonary fistula: a case report.

Project description:BackgroundAortopulmonary fistula is a rare complication of ascending aorta pathology. Presentation is most commonly dramatic with acute onset chest pain or heart failure secondary to left to right shunting. We describe a patient with acquired aortopulmonary fistula who had an insidious onset of heart failure as his presenting complaint. We also highlight the utility of multimodality cardiac imaging in establishing the diagnosis.Case summaryA 79-year-old male patient with a history of coronary artery bypass graft surgery and mechanical aortic valve replacement, 23 years prior, presented with exertional dyspnoea of 7 months duration. An initial workup that included transthoracic and transoesophageal echocardiography as well as coronary and bypass graft angiography failed to diagnose an acquired aortopulmonary fistula complicating an ascending aortic pseudoaneurysm. Upon referral to our institution, the correct diagnosis was suspected on off-axis transthoracic echocardiography. The fistula was subsequently confirmed, and the extent of ascending aorta pathology defined via a multimodality imaging approach that consisted of transoesophageal echocardiography and cardiac computed tomography. The patient underwent successful surgical repair and was discharged in a stable condition.DiscussionAcquired aortopulmonary fistula is a rare clinical entity. We describe a patient who had an insidious presentation of heart failure and found to have a large ascending aortic aneurysm that eroded into the main pulmonary artery creating a fistulous communication. The diagnosis was delayed and required a high index of suspicion and multimodality cardiac imaging.

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