Aspiration with or without lavage in the treatment of acute suppurative thyroiditis secondary to pyriform sinus fistula

Abstract

Objective There is currently no consensus regarding the optimal management of acute suppurative thyroiditis (AST) secondary to pyriform sinus fistula (PSF). To investigate the benefits and adverse events of aspiration with or without lavage for the treatment of AST secondary to PSF. Subjects and methods This was a retrospective analysis of consecutive patients with AST secondary to PSF who were admitted at the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University between August 2012 and December 2018. Clinical information, procedural data, and imaging data were analyzed. Results Seven patients (five women; mean age, 16.9 ± 6.3 years; range, 8-26 years) were included. The patients most presented with anterior neck pain and swelling (n = 7), fever (n = 7), or odynophagia (n = 5). Six cases of AST occurred on the left side of the thyroid and 1 on the right. All patients had thyroid abscess. AST was diagnosed by ultrasound-guided needle aspiration cytology in all cases. PSF was diagnosed during the inflammatory stage in five patients and during the quiescent stage in two. All patients were treated with empiric antibiotics. Needle aspiration without lavage was performed in three cases. Needle aspiration with lavage was performed in four cases. Repeat aspiration was performed in three cases. All patients recovered completely, with no procedure-related complications. During 18.3 ± 7.8 months of follow-up, AST recurred in one case. Excision of the PSF was performed in another case. Conclusion Ultrasound-guided aspiration with or without lavage had a good treatment effect and without adverse events for the management of AST secondary to PSF.

Acute Suppurative Thyroiditis in Childhood: An Atypical Presentation

“…However, negative findings on barium swallow testing do not rule out a tract, and direct laryngoscopy, CT with contrast, or MRI should be performed. When a fistula is identified, a range of treatment options can be considered, including endoscopic cauterization or complete surgical excision of the fistulous tract [ 19 ]. Moreover, thyroid function should be repeated in four to six weeks or if symptoms of hypothyroidism develop [ 17 ].…”

Clinical Analysis of Acute Suppurative Thyroiditis in 18 Children

“…Previous studies state that needle aspiration under US guidance is an effective and safe alternative to surgical therapy for AST. 11 , 22 , 23 However, the available studies were mostly case reports. In this study, we found that the length of hospitalization with antibiotics and US-guided needle aspiration treatment was the shortest among all treatments.…”

“…10 Most children with AST have anatomical abnormalities, such as cysts and PSF. 11,12 Branchial cleft cyst anomalies are more susceptible to thyroid infections and abscess formation. 13 PSF originates from a third or fourth branchial cleft cyst anomaly and forms a tract from the pyriform sinus to the left lobe of the thyroid almost exclusively.…”

A safe and effective surgical method for complex pyriform sinus fistula

“…Importantly, it is closely related to important structures such as the inferior thyroid cartilage, recurrent laryngeal nerve, and thyroid 31–33 . Generally, pyriform sinus fistula presents as repeated neck abscesses and acute purulent thyroiditis, which usually causes missed diagnoses 34–36 . Electronic laryngoscopy is the most intuitive way to observe the pyriform fossa.…”

“… 31 , 32 , 33 Generally, pyriform sinus fistula presents as repeated neck abscesses and acute purulent thyroiditis, which usually causes missed diagnoses. 34 , 35 , 36 Electronic laryngoscopy is the most intuitive way to observe the pyriform fossa. However, for traditional endoscopy, it is difficult to expose the whole bottom of the pyriform fossa.…”