New Onset Recurrent Acute Infectious Thyroiditis in an Adult Patient

Introduction: Acute infectious thyroiditis can be seen in patients with congenital abnormalities of the piriform sinus, underlying autoimmune disease, or the immunocompromised. In most patients, an upper respiratory tract infection precedes the development of the neck abscess. Case description: The patient is a 39-year-old Caucasian woman with history of Hidradenitis suppurativa (HS) and thrombocytopenia who presented to the hospital with sore throat, dysphagia and left-sided neck swelling. She was recently started on Humira for HS. Review of systems was significant for heat intolerance, weight loss, palpitations and panic attacks. Family history was positive for Hashimoto’s thyroiditis. Initial lab evaluation was significant for elevated erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), mildly elevated free T4 (FT4) with suppressed thyroid stimulating hormone (TSH). She was found to have a nearly 6 cm left-sided thyroid abscess, which was eventually drained. Contrasted CT imaging showed multiple left laryngeal space abscesses with extension to the left thyroid gland. TSH gradually increased over two months to nearly 4 times upper limit of normal accompanied by low normal FT4. TSI and TPO antibodies were negative. Clinical course was complicated by recurrent abscesses which required percutaneous drainage and intravenous antibiotics. Discussion: Acute infectious thyroiditis is extremely rare disorder of the thyroid gland in adults. Most patients present with recurrent abscesses early during childhood. Imaging studies such as CT scan, preferred over MRI, and barium swallow can show a fistula connecting the piriform sinus and left lobe of the thyroid gland. Treatment includes needle aspiration, followed by drainage and IV antibiotic therapy. Surgical excision of the entire sinus tract and the involved area of the thyroid gland is the best method to achieve definitive cure. Conclusion: Lower left-sided thyroid abscess extending from the pyriform fossa to the thyroid bed should raise the suspicion for underlying third or fourth branchial fistula. Most cases present during childhood, but one third of cases occur in adults. Surgical excision after confirming the presence of a fistulous tract with imaging is the treatment of choice.

Cervical Fracture with Piriform Sinus Laceration

Particular case of complex cervical trauma by associating a cervical fracture with piriform sinus laceration. The trauma is located in the anatomo-topographic zone II. Delayed onset at 24 hours of digestive symptoms, swallowing disorders, sialorrhea, dysphagia, subcutaneous cervical emphysema. CT with Optiray contrast agent is performed, an investigation that reveals a gap in the left piriform sinus of 5-6 mm. The evolution is favourable under conservative treatment, nasogastric tube, broad spectrum antibiotic treatment.

Epidermoid carcinoma of the hypopharynx in a child: a rare case report

<p>Epidermoid carcinoma is a frequent tumor in the upper aerodiodestive tracts, and depending on its location and tumor, nodes, metastases (TNM) stage, its therapy and prognosis vary enormously. Its location in the hypopharynx is rare, and in children or young adolescents, this location is extremely rare; The incriminated causes and the pathophysiology of the development of these tumors at this age remain a mystery. We present the case of a young patient of 13 years old, followed for squamous cell carcinoma of the right piriform sinus, with contralateral synchronous tonsil localization, and right lateral cervical lymphadenopathy fixed at 5 cm. In the absence of existing guidelines on the management of this type of location at this age, a multi-disciplinary meeting was necessary to decide on the management of this difficult case at this age.</p>

Ectopic Parathyroid Adenoma in Piriform Sinus: Case Report and Review of the Literature

During routine blood work, a 53-year-old female patient was noted to have asymptomatic hypercalcemia and subsequently found to have hyperparathyroidism. Localization studies for a suspected parathyroid adenoma included 99mTc Sestamibi scintigraphy, Single Photon Emission Computed Tomography (SPECT)/computed tomography (CT) study, and ultrasound of the neck, which were initially read as negative for parathyroid adenoma. A contrast-enhanced CT scan of the neck was performed to locate the suspected parathyroid adenoma and demonstrated a soft tissue lesion within the right piriform sinus. Flexible fiber optic nasolaryngoscopy revealed a submucosal lesion in the right piriform sinus. Following these findings, the initial 99mTc Sestamibi scintigraphy and SPECT/CT were reviewed with confirmation of a focal area of increased activity superior to the right thyroid lobe, corresponding to a nodule in the right piriform sinus that demonstrated increased activity on SPECT/CT. The patient was brought to the operating room for surgical management where a laryngoscope and operating microscope were utilized. The encapsulated lesion was dissected and excised in total. The parathyroid hormone and ionized calcium levels normalized postoperatively. Pathology confirmed a parathyroid adenoma. Parathyroid adenomas are the most common cause of primary hyperparathyroidism. Sixteen percent of parathyroid adenomas can be situated in an ectopic location. Ectopic parathyroid adenomas in the piriform sinus are rare with only a few previously documented cases. We document a rare case of ectopic parathyroid adenoma in the piriform sinus overlooked on initial imaging studies. These lesions can be challenging to localize, however, an understanding of embryology, close scrutiny of possible ectopic locations, and the application of complementary imaging techniques may prove useful for surgeons and clinicians.