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Katayama S, Oshio T, Ohtsu K, Sasaki K, Nakahara Y, Toyooka K, Hanaki S, Kawamoto K. Closure of the Entire Fistula With Highly Effective Chemocauterization Using the Distal Hood Endoscope: A Novel Procedure for the Treatment of Pyriform Sinus Fistula. Cureus 2024; 16:e59245. [PMID: 38813274 PMCID: PMC11134518 DOI: 10.7759/cureus.59245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Pyriform sinus fistula (PSF) causes a recurrent abscess in the neck. Endoscopic chemocauterization with trichloroacetic acid (TCA) for PSF is a simple, reproducible, and reliable procedure for treating PSF; however, there is concern about complications caused by TCA overflowing into the larynx. To prevent these complications, we devised a highly effective chemocauterization using a distal hooded endoscope (HuDHE). Our aim is to determine the efficacy and safety of HuDHE in children with PSF. METHODS The main features of HuDHE are as follows (1) an endoscope with a translucent silicon hood at the tip was made; (2) TCA was endoscopically injected into the PSF; and (3) the color change of the mucosa into PSF was endoscopically evaluated. Data on children receiving HuDHE for PSF in the past seven years were collected from medical records. RESULTS Data were obtained for eight children receiving HuDHE. The success rate of treatment for PSF after the first TCA chemocauterization was 87.5% (7/8) and the cumulative success rate after the second treatment was 100% (8/8). None of the children had recurrent PSF or serious complications such as vocal cord paralysis after HuDHE. CONCLUSION HuDHE appears to be a less invasive, safe, and effective treatment for PSF.
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Affiliation(s)
| | | | - Kazuhiro Ohtsu
- Pediatric Surgery, Hiroshima Prefectural Hospital, Hiroshima, JPN
| | - Kiyoshi Sasaki
- Pediatric Surgery, Kochi Health Sciences Center, Kochi, JPN
| | - Yasuo Nakahara
- Pediatric Surgery, National Hospital Organization Okayama Medical Center, Okayama, JPN
| | - Kosuke Toyooka
- Pediatric Surgery, Kurashiki Central Hospital, Kurashiki, JPN
| | - Shojiro Hanaki
- Pediatric Surgery, Kurashiki Central Hospital, Kurashiki, JPN
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Seyedjavadeyn Z, Miratashi Yazdi SA, Samimiat A, Vahedi M. Thyrotoxicosis as a rare presentation in acute suppurative thyroiditis: a case report. J Med Case Rep 2023; 17:428. [PMID: 37833794 PMCID: PMC10576297 DOI: 10.1186/s13256-023-04119-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/04/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Acute suppurative thyroiditis is a rare and potentially life-threatening disease. A few cases of acute suppurative thyroiditis associated with thyrotoxicosis have been reported in adults. We report a case of acute suppurative thyroiditis that was associated with thyrotoxicosis. CASE PRESENTATION We report the case of a 49-year-old Iranian female presented with a painful neck swelling for a week. Computed tomography showed a well-defined gas-filled collection in the left thyroid lobe with an enhancing margin. The patient underwent two-phase surgery, first left thyroid abscess drainage and then total thyroidectomy. The result of histopathology examination was multinodular goiter with abscess formation without malignancy. CONCLUSION Abscess formation and thyrotoxicosis is a very rare condition that occurs at the same time in acute suppurative thyroiditis. Despite antibiotic therapy being the first line of treatment, surgery is also required when antibiotic therapy fails.
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Affiliation(s)
- Zeynab Seyedjavadeyn
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Samimiat
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Matin Vahedi
- Department of General Thoracic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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3
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Congenital pyriform sinus fistula in a child: Transoral semiconductor laser cauterization and closure by nonabsorbable suture using the ORBEYE exoscope. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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4
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Baba HO, Salih AM, Hammood ZD, Rashid RJ, Abdullah IY, kakamad FH, Abdulla BA. Acute suppurative thyroiditis progressing to a thyroid abscess; a case report with review of literature. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2021.100433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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5
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Zhao L, Chen L, Li W, Ni K, Chen W, Li X. Retrospective review of 70 cases of pyriform sinus fistula. Int J Pediatr Otorhinolaryngol 2021; 150:110904. [PMID: 34479061 DOI: 10.1016/j.ijporl.2021.110904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/07/2021] [Accepted: 08/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pyriform sinus fistula (PSF) is a rare branchial pouch anomaly of the neck that presents a diagnostic and management challenge. The objective of this study is to highlight the value of intraoperative suspension laryngoscope-assisted methylene blue injection through the internal opening as a guide for locating the fistula. METHODS A retrospective study of 70 cases of PSF in children from 2009 to 2017 was managed, and an intraoperative suspension laryngoscope-assisted method combined with neck exploration and excision of the tract were performed in all cases. RESULTS The patients comprised 36 males and 34 females ranging in age from 7 days to 15 years. Sixty-four cases were predominantly left-sided (64/70, 91.4%), and 6 cases (6/70, 8.6%) occurred on the right side. Four cases exhibited temporary postoperative hoarseness (4/70, 5.7%), which disappeared after one week. There were no instances of recurrence during follow-up ranging from two to nine years, and the median follow-up period was four years. CONCLUSION The use of our surgical approaches can facilitate the localization of the fistula during dissection in open neck surgery, and reduce recurrence.
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Affiliation(s)
- Limin Zhao
- Department of Otorhinolaryngology & Head and Neck Surgery, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200062, China.
| | - Le Chen
- Department of Otorhinolaryngology, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, 200031, China.
| | - Wanpeng Li
- Department of Otorhinolaryngology & Head and Neck Surgery, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200062, China; Department of Otorhinolaryngology, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, 200031, China.
| | - Kun Ni
- Department of Otorhinolaryngology & Head and Neck Surgery, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200062, China.
| | - Wei Chen
- Department of Otorhinolaryngology & Head and Neck Surgery, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200062, China.
| | - Xiaoyan Li
- Department of Otorhinolaryngology & Head and Neck Surgery, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200062, China.
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Masuoka H, Miyauchi A, Sasaki T, Sano T, Miya A. Outcomes of endoscopic chemo- and laser-cauterizations and open fistulectomy for pyriform sinus fistula. J Otolaryngol Head Neck Surg 2021; 50:49. [PMID: 34384497 PMCID: PMC8359035 DOI: 10.1186/s40463-021-00537-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 08/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background Acute suppurative thyroiditis through the congenital pyriform sinus fistula (PSF) often recurs if the fistula is not resected. Although endoscopic chemo-cauterization (ECC) to obliterate the orifice of the fistula is less invasive than open fistulectomy, it may require repeated treatments. We recently adopted an endoscopic diode laser-cauterization (ELC) system with the intention of improving treatment outcomes in PSF. Here, we describe ELC and compare the outcomes of these three modalities. Methods We evaluated 83 patients with PSF who underwent treatment between 2007 and 2018 at Kuma Hospital, a tertiary thyroid treatment hospital. ECC and ELC were implemented in 2007 and 2015, respectively. Patients who were ineligible for the endoscopic procedures underwent open fistulectomy. Barium swallow studies and computed tomography scan under a trumpet maneuver were performed after treatment to evaluate obliteration or removal of the fistula. Results In total, 70 of the 81 (86%) patients who underwent barium swallow studies after the first treatment achieved obliteration or removal of the fistula. The success rates for open fistulectomy, ECC, and ELC were 100% (9/9), 83% (49/59), and 100% (13/13), respectively. ECC and ELC had significantly shorter operative times and lower blood loss than open fistulectomy. Insufficient opening of the mouth was the major reason for converting endoscopic procedures to open fistulectomy. Conclusions ELC may yield superior outcomes and is therefore the optimal treatment modality for PSF. However, it is still associated with certain limitations. Thus, treatment selection remains dependent on the shape and size of the PSF and the mouth opening of the individual patient. Graphical Abstract ![]()
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Affiliation(s)
- Hiroo Masuoka
- Department of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-Ku, Kobe, Hyogo, 650-0011, Japan.
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-Ku, Kobe, Hyogo, 650-0011, Japan
| | - Takahiro Sasaki
- Department of Head and Neck Surgery, Kuma Hospital, Kobe, Japan
| | - Tsutomu Sano
- Department of Head and Neck Surgery, Kuma Hospital, Kobe, Japan
| | - Akihiro Miya
- Department of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-Ku, Kobe, Hyogo, 650-0011, Japan
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Lafontaine N, Learoyd D, Farrel S, Wong R. Suppurative thyroiditis: Systematic review and clinical guidance. Clin Endocrinol (Oxf) 2021; 95:253-264. [PMID: 33559162 DOI: 10.1111/cen.14440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Acute suppurative thyroiditis (AST) is a rare but potentially fatal condition which can initially be difficult to distinguish from the more common subacute thyroiditis (SAT). We aim to update understanding of this medical emergency. DESIGN A systematic review over the past 20 years was performed on the epidemiology, clinical features, investigations, management and outcomes of AST. All full-text cases of microscopy or culture- proven AST in the English literature were included. RESULTS 200 cases of AST have been described in 148 articles from January 2000 - January 2020. Bacterial AST is most common, often presenting with neck pain (89%) and fever (82%). Immunosuppression and pyriform sinus fistula are the most common causes, most often due to gram-positive aerobes. Transient hyperthyroidism is common (42%). Aspiration and antibiotics are becoming a more common treatment. Overall mortality was 7.8%. Tuberculous and fungal AST are less likely to present with fever and neck pain. Fungal AST is more common in immunosuppressed individuals (31%) and has a high overall mortality (33%). Tuberculous AST is more common in TB endemic areas. CONCLUSION The symptoms and signs of AST commonly overlap with SAT and initially can be hard to diagnose. AST can be rapidly morbid or even fatal. Clinicians need to consider AST when they assess patients with thyroiditis who are systemically unwell, have high fever, high white cell count and c-reactive protein, tender neck and abnormal neck imaging. An investigative and treatment strategy is described based on a systematic review of the literature.
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Affiliation(s)
- Nicole Lafontaine
- Endocrinology and Diabetes Department, Eastern Health, Melbourne, Vic., Australia
- Medical School, University of Western Australia, Perth, WA, Australia
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Diana Learoyd
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Stephen Farrel
- Endocrine Surgery Department, St Vincent's Hospital, Melbourne, Vic., Australia
- Endocrine Surgery Department, Austin Health, Melbourne, Vic., Australia
- Endocrine Surgery Department, Royal Children's Hospital, Melbourne, Vic., Australia
| | - Rosemary Wong
- Endocrinology and Diabetes Department, Eastern Health, Melbourne, Vic., Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
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Troshina EA, Panfilova EA, Mikhina MS, Kim IV, Senyushkina ES, Glibka AA, Shifman BM, Larina AA, Sheremeta MS, Degtyarev MV, Rumyanstsev PO, Kuznetzov NS, Melnichenko GA, Dedov II. [Clinical practice guidelines for acute and chronic thyroiditis (excluding autoimmune thyroiditis)]. ACTA ACUST UNITED AC 2021; 67:57-83. [PMID: 34004104 PMCID: PMC8926135 DOI: 10.14341/probl12747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 01/25/2023]
Abstract
Острые и хронические заболевания щитовидной железы занимают второе место по выявляемости после сахарного диабета. Всемирная организация здравоохранения отмечает ежегодную тенденцию к увеличению числа заболеваний щитовидной железы. В настоящих клинических рекомендациях будут рассмотрены вопросы этиологии, клинического течения, диагностики и лечения острых и хронических (за исключением аутоиммунного) воспалительных заболеваний щитовидной железы.Клинические рекомендации — это основной рабочий инструмент практикующего врача, как специалиста, так и врача узкой практики. Лаконичность, структурированность сведений об определенной нозологии, методов ее диагностики и лечения, базирующихся на принципах доказательной медицины, позволяют в короткий срок дать тот или иной ответ на интересующий вопрос специалисту, добиваться максимальной эффективности и персонализации лечения.Клинические рекомендации составлены профессиональным сообществом узких специалистов, одобрены экспертным советом Министерства здравоохранения РФ. Представленные рекомендации содержат максимально полную информацию, которая требуется на этапе диагностики острых и хронических тиреоидитов, этапе выбора тактики ведения пациентов с тиреоидитом, а также на этапе лечения пациента.Рабочая группа представляет этот проект в профессиональном журнале, посвященном актуальным проблемам эндокринологии, с целью повышения качества оказываемой медицинской помощи, повышения эффективности лечения острых и хронических тиреоидитов путем ознакомления с полным тестом клинических рекомендаций по острым и хроническим тиреоидитам (исключая аутоиммунный тиреоидит) максимально возможного количества специалистов в области не только эндокринологии, но и медицины общей (семейной) практики.
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Affiliation(s)
| | | | | | - I V Kim
- Endocrinology Research Centre
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Chen T, Chen J, Sheng Q, Zhu L, Bai X, Xu W, Liu J, Li X, Lv Z. Pyriform sinus fistula in children: A comparison of endoscopic-assisted surgery and endoscopic radiofrequency ablation. J Pediatr Surg 2021; 56:800-804. [PMID: 32709530 DOI: 10.1016/j.jpedsurg.2020.06.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/02/2020] [Accepted: 06/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pyriform sinus fistula (PSF) is a rare congenital anomaly, and the preferred definitive treatment is yet to be verified. In this study, we investigated the treatment outcomes of PSF specifically comparing endoscopic-assisted surgery and endoscopic radiofrequency ablation (RA). METHODS The medical records of patients treated for PSF at the Shanghai Children's Hospital between October 2016 and September 2019 were retrospectively evaluated. RESULTS There were 93 girls and 98 boys. The median age at onset and operation was 3 years and 5 years, respectively. Endoscopic-assisted surgery was performed in 143 patients. During the same period, RA was performed in 48 patients, and 10 of them concurrently underwent incision and drainage of neck abscesses. Longer hospital stay was found in the endoscopic-assisted surgery group than in the RA group (10.50 ± 3.93 vs. 5.02 ± 3.30 days, P < 0.001). Postoperative complications were not significantly different between the two groups, except for neck infection (0 vs. 8.3%, P = 0.004). After a median follow-up period of 21 months, no significant difference was found between the two groups in terms of recurrence (1.4% vs. 0, P = 0.560). CONCLUSION Patients treated with RA had a significantly shorter hospital stay than those treated with endoscopic-assisted surgery. Outcomes of endoscopic-assisted surgery and RA were not significantly different for the management of PSF and treatment method should be tailored to the patient. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tong Chen
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, PR China
| | - Jianglong Chen
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, PR China
| | - Qingfeng Sheng
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, PR China
| | - Linlin Zhu
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, PR China
| | - Xiaoling Bai
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, PR China
| | - Weijue Xu
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, PR China
| | - Jiangbin Liu
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, PR China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, PR China.
| | - Zhibao Lv
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, PR China.
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Pu S, Li W, Xu H, Zhao L, Liu X, Li X. Open Surgical Excision Versus Endoscopic Radiofrequency Ablation for Piriform Fossa Fistula. EAR, NOSE & THROAT JOURNAL 2020; 100:700S-706S. [PMID: 32070124 DOI: 10.1177/0145561319898941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The purpose of this study is to explore the curative effect of open surgical excision and endoscopic radiofrequency ablation (RA) in the treatment of piriform fossa fistula (PSF). METHODS Retrospective study of 80 cases of PSF in the Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, from June 2009 to June 2017. RESULTS In this series, there were 43 males and 37 females, and the mean age was 5.2 years (17 days to 12 years). Surgical excision was performed for 62 patients. Radiofrequency ablation was performed for 18 patients. Six cases of postoperative temporary hoarseness occurred, and the hoarseness rates were not significantly different between the excision and RA groups (6.4% vs 11.1%, respectively, P = .88). Two cases of temporary neck abscess occurred in the RA group. After the mean follow-up period of 3.1 years (1-8 years), no recurrence was found between the excision and RA groups. CONCLUSIONS The curative effect of excision and RA for PSF is not significantly different; each of the 2 methods has its advantages and disadvantages. However, RA for PSF has the merit of being minimally invasive, easy to operate, and safe; this procedure seems to be more suitable in the clinic.
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Affiliation(s)
- Shilei Pu
- Department of Otolaryngology-Head and Neck Surgery, 36777Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Wanpeng Li
- Department of Otolaryngology-Head and Neck Surgery, 36777Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Department of Otorhinolaryngology, EYE and ENT Hospital of Fudan University, Shanghai, People's Republic of China
| | - Hongming Xu
- Department of Otolaryngology-Head and Neck Surgery, 36777Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Liming Zhao
- Department of Otolaryngology-Head and Neck Surgery, 36777Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xiaojun Liu
- Department of Otolaryngology-Head and Neck Surgery, 36777Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, 36777Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Yedla N, Pirela D, Manzano A, Tuda C, Lo Presti S. Thyroid Abscess: Challenges in Diagnosis and Management. J Investig Med High Impact Case Rep 2018; 6:2324709618778709. [PMID: 29854858 PMCID: PMC5971374 DOI: 10.1177/2324709618778709] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/05/2018] [Accepted: 04/21/2018] [Indexed: 12/02/2022] Open
Abstract
Thyroid abscess is an uncommon infectious pathology. The thyroid is highly resistant to infection due to high iodine content, capsular encasement, and rich vascularity. Acute suppurative thyroiditis represents <1% of thyroid diseases that could potentially become a life-threatening endocrine emergency. A 48-year-old woman with AIDS presented with 3 days of fever, tender neck swelling, and methicillin-resistant Staphylococcus aureus bacteremia. Apart from leukocytosis, initial laboratory values including thyroid function tests were normal. The initial plain computed tomography scan of the neck and ultrasound scan of the neck were inconclusive as well. By day 4, she worsened, and on repeat computed tomography scan of the neck with contrast, multiloculated abscesses in the thyroid and retro pharynx were seen, which needed emergent drainage. Acute suppurative thyroiditis, a rare disease, occurs in patients with either preexisting disorders of the thyroid or in the immunocompromised. The most common pathogen is Staphylococcus aureus. In our case, we highlight the fact that initial imaging may be negative in the early stages of acute suppurative thyroiditis and lead to an erroneous diagnosis of subacute thyroiditis. There are less than 5 cases of methicillin-resistant Staphylococcus aureus suppurative thyroiditis reported.
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Affiliation(s)
| | | | - Alex Manzano
- Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Claudio Tuda
- Mount Sinai Medical Center, Miami Beach, FL, USA
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12
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Acute Suppurative Thyroiditis in an Intravenous Drug User with a Preexisting Goiter. Case Rep Med 2018; 2018:5098712. [PMID: 29780423 PMCID: PMC5892251 DOI: 10.1155/2018/5098712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 02/27/2018] [Indexed: 11/18/2022] Open
Abstract
Acute suppurative thyroiditis (AST) is an uncommon, potentially life-threatening cause of a rapidly enlarging neck mass. It may present similarly to subacute thyroiditis, a relatively benign and self-limiting condition. We report a case of AST in an adult intravenous (IV) drug user with a preexisting goiter who presented with a left forearm abscess that grew methicillin-sensitive Staphylococcus aureus. In this particular case, clinical suspicion for AST was high. As a result, early IV antibiotic therapy was initiated, and this led to rapid clinical improvement furthermore preventing airway compromise. To our knowledge, this is the first case of AST in the literature resulting from likely hematogenous spread in the setting of IV drug use and a preexisting goiter. Overall, this case highlights the importance of assessing risk factors for AST in patients whose presentations may seem more typical of subacute thyroiditis. Such an approach will lead to timely diagnosis and treatment to avoid potentially devastating consequences.
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13
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Lammers D, Campbell R, Davila J, MacCormick J. Bilateral Piriform sinus fistulas: a case study and review of management options. J Otolaryngol Head Neck Surg 2018; 47:16. [PMID: 29444706 PMCID: PMC5813382 DOI: 10.1186/s40463-018-0258-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/29/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Piriform sinus fistulas occur due to developmental abnormalities of the third and fourth branchial arches, and almost always occur unilaterally. They generally present as recurrent abscesses in the anterior-inferior neck, with concurrent thyroiditis. They have conventionally been managed with complete removal of the sinus tract, and thyroidectomy if required; however, endoscopic approaches have been increasingly favored. Herein we describe a case of bilateral piriform sinus fistulas, and present a review of the literature concerning their endoscopic management. CASE PRESENTATION Our patient was determined to have bilateral piriform sinus fistulas based on computer tomography, magnetic resonance imaging and microlaryngoscopy. We performed electrocauterization of the proximal fistula tracts, followed by injection of fibrin sealent. Our patient has not had a recurrence in the ten months since his procedure. There were no complications. Twenty-three articles describing an endoscopic approach to these fistulas were identified through PubMed, and a search through the references of related articles was completed. CONCLUSION Of one hundred and ninety-five patient cases we reviewed, an endoscopic procedure success rate of 82% and complication rate of 5.6% was determined. Piriform sinus fistulas that occur bilaterally are a rare congenital abnormality of the neck. Endoscopic approaches are an acceptable alternative option to open procedures, with similar success and a lower rate of complications.
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Affiliation(s)
- Deanna Lammers
- University of Ottawa Faculty of Medicine, Roger Guindon Hall, 451 Smyth Rd., Ottawa, ON K1H 8M5 Canada
| | - Ross Campbell
- Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1 Canada
| | - Jorge Davila
- Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1 Canada
| | - Johnna MacCormick
- Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1 Canada
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Endoscopic electrocauterization of pyriform sinus fistula. Eur Arch Otorhinolaryngol 2017; 274:3927-3931. [PMID: 28836049 DOI: 10.1007/s00405-017-4713-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/10/2017] [Indexed: 12/16/2022]
Abstract
To determine the efficacy of endoscopic electrocauterization for pyriform sinus fistula (PSF) using a flexible Bugbee cautery electrode. From 2009 to 2016, a total of eight patients with acute suppurative thyroiditis or cervical abscess secondary to PSF were retrospectively registered in our study (three males, five females; median age 6.5 years). All patients underwent endoscopic electrocauterization as treatment for PSF. Six of eight patients had no recurrence after the initial endoscopic electrocauterization of PSF. One patient with recurrence developed symptoms 9 days after cauterization and another experienced recurrence after 2 years. Mean follow-up for the eight patients was 50 months (range 5-96 months). No post-operative complication was reported. Endoscopic electrocauterization appears to be a less-invasive, safe, and effective method for the treatment of PSF.
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Yanagisawa S, Oshio T, Kato M, Kano M, Tsuji Y, Morikawa Y. Endoscopic chemocauterization for pyriform sinus fistula in children. Pediatr Int 2017; 59:807-811. [PMID: 28387991 DOI: 10.1111/ped.13294] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 02/25/2017] [Accepted: 03/30/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although complete excision is the standard treatment for pyriform sinus fistula (PSF), it has recently been suggested that chemocauterization via the internal orifice of the fistula could be an effective non-invasive treatment for the condition. The present report describes the details of our experience with and the efficacy of endoscopic chemocauterization for pediatric PSF. METHOD Between January 2010 and June 2015, four patients were diagnosed with PSF and scheduled to undergo endoscopic chemocauterization. Under general anesthesia, trichloroacetic acid (TCA) solution was endoscopically injected through the opening of the fistula using a fine plastic tube. Esophagogram was obtained at 3 weeks after the procedure to search for recurrence. Complete closure of the fistula was confirmed on endoscopy at 2-3 months after chemocauterization. RESULTS Two of the four patients were treated once, and the remaining patients required further chemocauterization procedures. No recurrence developed in any patient after it had been confirmed that the fistula's internal orifice had been obliterated. Some transient complications, such as sore throat, nausea or temporary vocal fold paresis, occurred. CONCLUSION Chemocauterization with TCA seems to be a useful first-choice treatment for PSF.
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Affiliation(s)
- Satohiko Yanagisawa
- Department of Pediatric Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Takehito Oshio
- Department of Pediatric Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan.,Department of Pediatric Surgery, Shikoku Central Hospital, Shikokuchuo, Ehime, Japan
| | - Mototoshi Kato
- Department of Pediatric Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Motohiro Kano
- Department of Pediatric Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Yuki Tsuji
- Department of Pediatric Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Yasuhide Morikawa
- Department of Pediatric Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
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San Martin VT, Kausel AM, Albu JB. Haemophilus Influenzae As A Rare Cause Of Acute Suppurative Thyroiditis With Thyrotoxicosis And Thyroid Abscess Formation In A Patient With Pre-Existent Multinodular Goiter. AACE Clin Case Rep 2017. [DOI: 10.4158/ep161244.cr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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17
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Yamazaki K, Shinbori K, Omata J, Yokoyama Y, Baba H, Aizawa N, Hashimoto S, Horii A. Successful transoral surgical closure of a hypopharyngeal pyriform sinus fistula: a case report. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2016. [DOI: 10.1080/23772484.2016.1244470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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KTP laser assisted endoscopic tissue fibrin glue biocauterization for congenital pyriform sinus fistula in children. Int J Pediatr Otorhinolaryngol 2016; 85:115-9. [PMID: 27240509 DOI: 10.1016/j.ijporl.2016.03.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/19/2016] [Accepted: 03/19/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aims to assess the efficacy of a novel endoscopic management for congenital pyriform sinus fistula (CPSF) using potassium titanyl phosphate (KTP) laser assisted endoscopic tissue fibrin glue biocauterization in children. METHOD From 2010 to 2014, a total of 5 children with recurrent or acute suppurative thyroiditis or neck abscess secondary to CPSF were enrolled retrospectively in this study. RESULTS Mean age at the first time of endoscopic biocauterization was 6.2 ± 0.7 (5-7) years. The barium swallow study detected a fistula in four cases. Endoscopy identified an internal opening at the pyriform sinus in all cases with four on the left side and one on the right side. All patients underwent KTP laser assisted endoscopic tissue fibrin glue biocauterization as treatment for CPSF. Only one case required the second endoscopic procedure due to fluctuation of symptoms. Post-endoscopic follow-up duration of these patients was 24.6 ± 11.6 (7-36) months. Neither complications nor recurrences were noted during follow-up in all patients. CONCLUSIONS For children presenting with repeated acute suppurative thyroiditis or neck infections, clinicians should highly suspect the possibility of CPSF. Endoscopy should be performed not only to confirm the diagnosis but also could be served as an initial treatment modality of biocauterization by KTP laser and tissue fibrin glue, which was demonstrated as a less invasive, safe, and effective method in children.
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19
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Successful endoscopic ablation of a pyriform sinus fistula in a child: case report and literature review. Pediatr Surg Int 2016; 32:623-7. [PMID: 26820515 DOI: 10.1007/s00383-016-3868-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2016] [Indexed: 12/23/2022]
Abstract
Recurrent thyroid infections are rare in children. When present, patients should be evaluated for anatomic anomalies such as pyriform sinus fistulae. We describe a 12-year-old girl with history of recurrent thyroid abscesses secondary to a pyriform sinus fistula and managed with concurrent endoscopic ablation and incision and drainage.
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20
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Lachance S, Chadha NK. Systematic Review of Endoscopic Obliteration Techniques for Managing Congenital Piriform Fossa Sinus Tracts in Children. Otolaryngol Head Neck Surg 2015; 154:241-6. [PMID: 26527612 DOI: 10.1177/0194599815613286] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/01/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Piriform fossa sinus tracts (PFSTs) are a recognized cause of recurrent deep neck infections in the pediatric population. Conventional management has historically required open resection, but over recent years minimally invasive endoscopic approaches to obliterate the pharyngeal opening of the sinus have been performed in many centers. However, there is a lack of clear evidence regarding the success rate and safety of these approaches. OBJECTIVE To determine the success rate of endoscopic management of PFST through a systematic review of the existing literature. DATA SOURCES MEDLINE (1964-2014) and bibliographies of identified papers. REVIEW METHODS Two authors independently reviewed 170 abstracts and identified relevant studies for full-text review. Data were independently extracted from those studies, and the Oxford Centre for Evidence-Based Medicine guidelines were used to classify the level of evidence. RESULTS Thirteen studies met the inclusion criteria, comprising a total of 84 patients. All included studies were evidence level 4 (case series). Various methods of obliterating the PFST were described: electrocautery (n = 39), laser (n = 19), trichloroacetic acid (n = 19), silver nitrate (n = 4), combination of silver nitrate and laser (n = 2), and fibrin glue (n = 1). The success rate for endoscopic management of PFST was 89.3% overall (90.5% in primary cases and 85.7% in revision cases). The only adverse event reported was temporary vocal cord immobility in 2.4% (n = 2) of cases. CONCLUSION Endoscopic management of pediatric PFST appears to be safe and effective, as a primary option and for revision after open surgery.
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Affiliation(s)
- Sophie Lachance
- Département d'Oto-rhino-laryngologie et chirurgie cervico-faciale, CHUL, CHU de Québec, Québec, Canada Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, Vancouver, Canada
| | - Neil K Chadha
- Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, Vancouver, Canada University of British Columbia, Vancouver, Canada
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Derks LSM, Veenstra HJ, Oomen KPQ, Speleman L, Stegeman I. Surgery versus endoscopic cauterization in patients with third or fourth branchial pouch sinuses: A systematic review. Laryngoscope 2015; 126:212-7. [PMID: 26372400 DOI: 10.1002/lary.25321] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To systematically review the current literature on treatment of third and fourth branchial pouch sinuses with endoscopic cauterization, including chemocauterization and electrocauterization, in comparison to surgical treatment. DATA SOURCES PubMed, Embase, and the Cochrane Library. REVIEW METHODS We conducted a systematic search. Studies reporting original study data were included. After assessing the directness of evidence and risk of bias, studies with a low directness of evidence or a high risk of bias were excluded from analysis. Cumulative success rates after initial and recurrent treatments were calculated for both methods. A meta-analysis was conducted comparing the success rate of electrocauterization and surgery. RESULTS A total of 2,263 articles were retrieved, of which seven retrospective and one prospective article were eligible for analysis. The cumulative success rate after primary treatment with cauterization ranged from 66.7% to 100%, and ranged from 77.8% to 100% after a second cauterization. The cumulative success rate after the first surgical treatment ranged from 50% to 100% and was 100% after the second surgical attempt. Meta-analysis on electrocauterization showed a nonsignificant risk ratio of 1.35 (95% confidence interval: 0.78-2.33). CONCLUSIONS The effectiveness of cauterization in preventing recurrence seems to be comparable to surgical treatment. However, we suggest endoscopic cauterization as the treatment of choice for third and fourth branchial pouch sinuses because of the lower morbidity rate.
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Affiliation(s)
- Laura S M Derks
- Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery, Utrecht, the Netherlands
| | - Hidde J Veenstra
- Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery, Utrecht, the Netherlands
| | - Karin P Q Oomen
- Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery, Utrecht, the Netherlands
| | - Lucienne Speleman
- Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery, Utrecht, the Netherlands
| | - Inge Stegeman
- Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery, Utrecht, the Netherlands.,Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
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A case of pyriform sinus fistula infection with double tracts. Case Rep Otolaryngol 2014; 2014:126840. [PMID: 25405046 PMCID: PMC4227360 DOI: 10.1155/2014/126840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 10/13/2014] [Accepted: 10/13/2014] [Indexed: 11/17/2022] Open
Abstract
Pyriform sinus fistula is a rare clinical entity and the precise origin remains controversial. The fistula is discovered among patients with acute suppurative thyroiditis or deep neck infection of the left side of the neck and is usually located in the left pyriform sinus. To the best of our knowledge, only a single tract has been reported to be responsible for pyriform sinus fistula infection. We present a case of a 13-year-old female patient with a pyriform sinus fistula that caused a deep infection of the left side of the neck and showed double-tract involvement discovered during surgical resection of the entire fistula. Both tracts arose around the pyriform sinus and terminated at the upper portion of the left lobe of the thyroid.
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Wu C, Zhang Y, Gong Y, Hou Y, Li S, Zou Y, Ge J. Two cases of bacterial suppurative thyroiditis caused by Streptococcus anginosus. Endocr Pathol 2013; 24:49-53. [PMID: 23435638 DOI: 10.1007/s12022-013-9236-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Acute suppurative thyroiditis (AST) is a rare clinical condition. Streptococcus anginosus has a propensity of producing empyema in the head and neck. Here, we reported two cases of AST caused by S. anginosus. A 44-year-old man presented with anterior neck tender swelling and odynophagia for 12 days. He had thyrotoxicosis. He was initially diagnosed as thyroid cancer due to the misleading computed tomography report. Fine needle aspiration (FNA) yielded pus and neutrophils. S. anginosus was isolated from pus. After aspiration of abscess and treatment with sensitive antibiotics, he recovered uneventfully with 3 weeks treatment. He was euthyroid 3 months later. The other case is a 40-year-old women complained of fever and left neck swelling for 20 days. Magnetic resonance imaging showed left neck inflammatory changes. FNA revealed pus and inflammatory cells infiltration. She had moderately decreased level of thyroid-stimulating hormone (TSH). Blood cultures were positive for S. anginosus. After penicillin treatment, TSH level returned to normal range, and the nodule gradually resolved. She recovered uneventfully after 5 weeks treatment. S. anginosus has a previously unappreciated clinical niche in AST. Once AST is clinically concerned, FNA procedure should be performed as early as possible.
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Affiliation(s)
- Chaoneng Wu
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, 200032, China
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Park JH, Jung YH, Sung MW, Kim KH. Temporary vocal fold immobility after chemocauterization of the pyriform sinus fistula opening with trichloroacetic acid. Laryngoscope 2012; 123:410-3. [PMID: 22847863 DOI: 10.1002/lary.23530] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 02/23/2012] [Accepted: 05/30/2012] [Indexed: 11/07/2022]
Affiliation(s)
- Joo Hyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Hospital, Seoul, South Korea
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25
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Lu WH, Feng L, Sang JZ, Wang L, Yuan LL, Gao L, Lou WH. Various presentations of fourth branchial pouch sinus tract during surgery. Acta Otolaryngol 2012; 132:540-5. [PMID: 22236038 DOI: 10.3109/00016489.2011.646010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION A recurrent neck abscess or acute suppurative thyroiditis should arouse suspicion of fourth branchial pouch sinus. Complete surgical excision is usually curative. The classification of sinus tract according to the area where it is emerging from the larynx may be helpful in identifying the tract during surgery. OBJECTIVE To describe our experience of the diagnosis and management of fourth branchial pouch sinus and elucidate three different emerging pathways of the sinus tract during surgery. METHODS Retrospective case series with eight patients who were diagnosed with fourth branchial pouch sinus between January 2007 and July 2011 at the First Affiliated Hospital of Zhengzhou University. RESULTS Six patients presented with recurrent neck abscess, two presented with acute suppurative thyroiditis. All patients had barium swallow and sinus tract was delineated in six cases. All eight patients underwent surgical excision of the sinus tract. Three different emerging pathways of the sinus tract were identified during surgery. The tract could penetrate the thyroid cartilage near the inferior horn, the inferior pharyngeal constrictor muscle or the cricothyroid membrane when it emerged from the larynx. The recurrent laryngeal nerve was commonly dissected to avoid inadvertent damage. Hemithyroidectomy was performed in six patients. All eight are currently asymptomatic.
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Cha W, Cho SW, Hah JH, Kwon TK, Sung MW, Kim KH. Chemocauterization of the internal opening with trichloroacetic acid as first-line treatment for pyriform sinus fistula. Head Neck 2012; 35:431-5. [DOI: 10.1002/hed.22998] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2012] [Indexed: 11/08/2022] Open
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27
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Spitzer M, Alexanian S, Farwell AP. Thyrotoxicosis with post-treatment hypothyroidism in a patient with acute suppurative thyroiditis due to porphyromonas. Thyroid 2012; 22:97-100. [PMID: 22136210 DOI: 10.1089/thy.2011.0159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Acute suppurative thyroiditis (AST) is a rare, life-threatening thyroid infection characterized by a tender neck mass and fever. As these features are shared with self-limited subacute thyroiditis (SAT), it is important to differentiate between the two disorders. PATIENT FINDINGS We report a case of AST in a 21-year-old woman who presented with steadily worsening throat pain for 3 weeks, a tender left neck mass, and thyrotoxicosis. She was initially given prednisone for treatment of presumed SAT but then it acutely worsened. Fine needle aspiration yielded pus on gross examination, and she required intubation and emergent surgical drainage to maintain her airway. Culture of the abscess isolated Streptococcus F and Porphyromonas, a gram-negative intracellular anaerobe not previously reported to cause AST. She improved quickly after surgery, developed transient hypothyroidism that did not require treatment with thyroid hormone, and is currently euthyroid. An abnormal piriform sinus fistula was identified on the left using an esophagram. SUMMARY AST may be difficult to clinically differentiate from SAT. Fine needle aspiration revealing pus, culture yielding bacteria or fungi, abscess on ultrasonography and computed tomography, and left-sided predominance are important in the diagnosis of AST. CONCLUSIONS AST should be considered in any patient with SAT who does not rapidly improve following institution of steroids. Further, the presence of thyrotoxicosis does not eliminate AST as an initial diagnosis.
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Affiliation(s)
- Matthew Spitzer
- Division of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, Massachusetts 01583, USA.
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Paes JE, Burman KD, Cohen J, Franklyn J, McHenry CR, Shoham S, Kloos RT. Acute bacterial suppurative thyroiditis: a clinical review and expert opinion. Thyroid 2010; 20:247-55. [PMID: 20144025 DOI: 10.1089/thy.2008.0146] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Acute suppurative thyroiditis (AST) resulting from a bacterial infection is an infrequent but potentially life-threatening endocrine emergency. Traditional management of this disease has been surgery in conjunction with targeted antibiotic therapy. Recent nonrandomized reports of small series have demonstrated good outcomes using less invasive approaches. No randomized clinical trials have been performed. Here, we provide a review of the literature and an approach to this problem based on expert opinion. METHODS The literature was reviewed utilizing PubMed, and a representative case of AST was presented to a panel of experts. Endocrinology, surgery, and infectious disease experts responded to a series of questions regarding diagnosis, management, prognosis, and harm. RESULTS Combining a broad spectrum of clinical expertise and the published literature, the authors suggest a clinical algorithm as a guide to management, addressing both diagnosis and acute and long-term management. CONCLUSIONS Published studies indicate a trend toward less invasive management during active inflammation and infection and regarding definite therapy. Remaining questions are presented to foster an evidence-based approach to this disease. Ideally, future randomized, controlled trials will provide data to improve the therapy and outcome of AST.
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Affiliation(s)
- John E Paes
- Endocrinology, Diabetes, and Metabolism Feedback Consulting, LLC and Westerville Medical Associates Central Ohio Primary Care Physicians, Inc., Westerville, Ohio 43081, USA.
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