Ultrasonographic Characteristics of Pyriform Sinus Fistulas Involving the Thyroid Gland

• Published in: Journal of ultrasound in medicine Vol. 37; no. 11; pp. 2631 - 2636
• Main Authors: Ahn, Dongbin, Lee, Gil Joon, Sohn, Jin Ho
• Format: Journal Article
• Language: English
• Published: England 01-11-2018
• Subjects: Adolescent; Adult; Aged; brachial cleft anomaly; Child; Child, Preschool; Female; Fistula; head and neck; Humans; Infant; Male; Middle Aged; pyriform sinus; Pyriform Sinus - abnormalities; Pyriform Sinus - diagnostic imaging; Respiratory Tract Fistula - diagnostic imaging; Retrospective Studies; Thyroid Diseases - diagnostic imaging; Thyroid Gland - diagnostic imaging; thyroid nodule; thyroid/parathyroid; thyroiditis; Ultrasonography; Young Adult; thyroid nodule; fistula; pyriform sinus; head and neck; thyroiditis; brachial cleft anomaly; thyroid/parathyroid
• ISSN: 0278-4297; 1550-9613
• DOI: 10.1002/jum.14623

Objectives
Ultrasonography (US) has been considered to have a more limited role in the diagnosis of pyriform sinus fistulas than computed tomography. The aim of this study was to evaluate the US characteristics of pyriform sinus fistulas involving the thyroid gland in an attempt to improve our ability to diagnose this condition using US.
Methods
Between 2005 and 2016, 14 patients with pyriform sinus fistulas presenting as suppurative thyroiditis or as thyroid nodules were enrolled in the study. Their US images were reviewed to identify US characteristics indicating the presence of an underlying pyriform sinus fistula and compared with the computed tomographic images.
Results
A hypoechoic tubular lesion across the thyroid gland was identified in 9 patients (64.3%). Hyperechoic foci or echogenic lines were found within the lesion in 10 patients (71.4%). A hypoechoic rim was found at the boundary of the lesion in 7 patients (50.0%). A lesion emerging from the posterolateral aspect of the thyroid cartilage was found in 4 patients (28.6%). Thirteen (92.9%) of the 14 patients had 1 of these 4 findings.
Conclusions
Ultrasonography would be a useful diagnostic modality for indicating the presence of an underlying pyriform sinus fistula in patients with suppurative thyroiditis or a thyroid nodule and can be used as a first‐line diagnostic tool to screen for pyriform sinus fistulas.