RESUMO
RATIONALE: There have been many reports of non-thyroidal lesions which can be mistaken for thyroidal lesions on ultrasound (US) examination. However, it is not known that pyriform sinus fistula (PSF) can manifest as an incidental thyroid nodule and cause serious complication on fine-needle aspiration (FNA). PATIENT CONCERNS: We present a 34-year-old man with PSF incidentally detected on US. US examination showed hypoechoic nodule with several bright echogenic spots at the uppermost part of left thyroid gland. With the suspicion of thyroid cancer, although there would have been some morphologic changes between the 2 US examinations, FNA was performed. DIAGNOSES: Cytologic specimen revealed some clusters of ciliated columnar cells mixed with inflammatory and lymphoid cells. On computed tomography (CT) before FNA, there were tiny air bubbles within the thyroid nodule. Laryngoscopy revealed fistula originating from the pyriform sinus. INTERVENTIONS: After FNA, he had to undergo tracheostomy and removal of abscess due to infectious complication. OUTCOMES: The deep neck abscesses and infections were controlled after the treatment. At 1 year after FNA, successful chemocauterization with 40% trichloracetic acid solution was performed for PSF found on laryngoscopy. LESSONS: PSF can manifest as an incidental thyroid nodule mimicking thyroid cancer. Special care should be taken when FNA is planned for the nodule with air foci and morphologic changeability at the uppermost part of left thyroid gland.
Assuntos
Biópsia por Agulha Fina/efeitos adversos , Cauterização/métodos , Fístula , Seio Piriforme , Abscesso Retrofaríngeo , Glândula Tireoide , Neoplasias da Glândula Tireoide/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Biópsia por Agulha Fina/métodos , Cáusticos/uso terapêutico , Diagnóstico Diferencial , Drenagem/métodos , Fístula/diagnóstico , Fístula/terapia , Humanos , Achados Incidentais , Laringoscopia/métodos , Masculino , Seio Piriforme/diagnóstico por imagem , Seio Piriforme/patologia , Abscesso Retrofaríngeo/diagnóstico , Abscesso Retrofaríngeo/etiologia , Abscesso Retrofaríngeo/prevenção & controle , Abscesso Retrofaríngeo/terapia , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Tomografia Computadorizada por Raios X/métodos , Traqueostomia/métodos , Resultado do Tratamento , Ácido Tricloroacético/administração & dosagem , Ultrassonografia/métodosRESUMO
The present study was undertaken for the purpose of elucidating the specific features of the past medical history and the etiological factors responsible for the development of tonsillogenic pharyngeal abscesses in the children. We performed the retrospective analysis of the medical histories of 291 children presenting with this condition who had been admitted for the treatment to the ENT Department of the Morozovskzya City Children's Clinical Hospital during the period from January till December 2015. The study has demonstrated the following most common shortcomings of the outpatient treatment of the patients suffering from chronic tonsillitis at the stage preceding formation of paratonsillar abscess: inadequate antibacterial therapy of acute chronic tonsillitis or its exacerbation and limited indications for tonsillectomy at the level of the outpatient treatment. The leading role in the etiology of tonsillogenic pharyngeal abscesses in the children is played by beta-hemolytic Streptococcus of group A. It is concluded that the medical history suggesting past paratonsillar abscess is the absolute indication for the subsequent tonsillectomy in the children of any age.
