Original ArticleRecurrent deep neck abscess and piriform sinus tract: A 15-year review on the diagnosis and management
Section snippets
Background/purpose
Piriform Sinus Tract (PST) is a very rare congenital condition presenting as a deep neck abscess or acute suppurative thyroiditis. Because of the rarity, the definitive diagnosis and hence the treatment are usually delayed. The purpose of this paper is to look into the possible factors leading to the delay in the diagnosis.
Materials and methods
All pediatric patients with a PST treated at the Prince of Wales Hospital between May 1997 and May 2012 were retrospectively reviewed. We investigated the demographic data, presentation, radiological investigations, surgical procedures, postoperative complications and outcome. In addition, the detailed information on those patients with delay in diagnosis including the number and timing of recurrence, and the interval between the inflammatory episode and contrast study was analyzed.
Results
Eighteen patients (13 girls and 5 boys) were diagnosed with PST during the 15-year period. The mean age at presentation was 5.4 years (ranged 2 days to 14 years). Sixteen patients (88.9%) presented with an acutely inflamed neck mass; two other patients – both neonate – presented with a non-inflamed neck lesion. Fourteen (77.8%) also had fever at presentation. Sixteen patients (88.9%) presented with a left-side lesion. Eleven (61.1%) had a preceding sore throat or evidence of an upper respiratory
Discussion
The thyroid gland has very high resistance against bacterial infection owing to its high iodine content, rich vascularity and the presence of a capsule that separates it from the neighboring source of infection [1], [2], [3]. Womack [4] demonstrated the ability of the thyroid gland to withstand infection by direct injection of bacteria into the superior thyroid artery of dog subjects. We should thus have high index of suspicion of an underlying abnormality whenever a case of acute suppurative
Conclusions
The diagnosis of piriform sinus tract is commonly delayed resulting in recurrent inflammation and potentially avoidable procedures. A high index of suspicion is therefore needed whenever children present with a left deep neck abscess or acute suppurative thyroiditis. A contrast swallow performed after the resolution of acute inflammation is the most useful investigation to identify a PST. In addition, US and CT may assist in making the diagnosis in selective cases. Managing neonates with a PST
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