Computed Tomography Findings of Complete Branchial Cleft Fistula

"Microtia, Branchial Cleft Fistula, and Tetralogy of Fallot: A Possible Association"

When searching over associations between congenital ear abnormalities, especially microtia and affiliated deformities like cleft lip or palate and congenital heart diseases, some clinical analysis and genetic theories are found. A 10-year-old boy sent to the plastic surgery hospital was puzzled by a congenital anterior auricular fistula with fluid trace for more than 9 years. The preoperative diagnoses were branchial cleft fistula and congenital left ear deformity with postoperation of TOF. By browsing over studies on genetic concerns and clinical performance, it may be attributed to a possible association between microtia, branchial cleft fistula, and tetralogy of Fallot, though whose fundamental mechanisms remain concerned.

Value of CT sinography and analysis of missed diagnosis and misdiagnosis for abdominal wall sinus

Background

The value of CT (computed tomography) sinography in evaluating abdominal wall sinus tracts is currently unclear. The present study aims to investigate the accuracy of CT sinography in diagnosing the extent of abdominal sinus and analyze the reasons for misdiagnosis.

Materials and methods

64 patients with abdominal sinus tract formation (including fistula) undergoing CT sinography in our hospital from January 2018 to November 2020 were retrospectively analyzed. The CT images were blindly and independently re-assessed by two radiologists with 5- and 18-years work experience, respectively. Whether the sinus tract was confined to the abdominal wall or had invaded the abdominal cavity, and whether there was fistula formation were evaluated. The accuracy of CT sinography in diagnosing sinus invasion in the abdominal cavity and fistula formation was calculated. The agreements of CT sinography-surgical results and inter-observer were assessed using weighted-kappa statistics.

Results

The weighted- Kappa of inter-observer agreement (0.825, P < 0.001) and CT sinography—surgical results (0.828, P < 0.001) were both perfect. The diagnostic accuracy, sensibility, and specificity of sinus tract confined to the abdominal wall were 90.6% (95% CI: 80.7–96.5), 85.7% (95% CI: 67.3–96.0), and 94.4% (95% CI: 81.3–99.3), respectively. The diagnostic accuracy, sensibility, and specificity of fistula formation were 93.8% (95% CI: 84.8–98.3), 89.5% (95% CI: 66.9–98.7), and 95.6% (95% CI: 84.9–99.5), respectively. A total of 4 cases of sinus tract confined to the abdominal wall were misdiagnosed as invading the abdominal cavity, 2 cases of sinus tract invading the abdominal cavity were misdiagnosed as confined to the abdominal wall, 2 cases of enterocutaneous fistula were missed, 1 case of enterocutaneous fistula was misdiagnosed, 1 case of vesico-cutaneous fistula was misdiagnosed, and no cases of vesico-cutaneous fistula were missed.

Conclusions

CT sinography can accurately assess the extent of an abdominal sinus tract and reveal fistula formation, despite some inevitable misdiagnosis and missed diagnosis. Radiologists should find more clues to improve the diagnostic accuracy.