Congenital dermoid fistulas of the anterior chest region (CDFACR): usefulness of sonography for complete resection

Abstract

Congenital dermoid fistulas of the anterior chest regions (CDFACRs) consist of a skin orifice at the anterior border of the sternocleidomastoid muscle with fistulas extending caudally in the subcutaneous tissue near the sternoclavicular joint. We report 2 pediatric CDFACR cases with pathognomonic sonography findings. By using sonography, we could diagnose the fistulas as CDFACRs by focusing on their location and direction and could reveal the distal side for complete resection. We suggest that sonography, which does not involve radiation or require sedation, is a better choice for the initial examination of CDFACRs than computed tomography or MRI.

Unusual presentation of congenital dermoid fistula of the anterior chest region

“…Although ultrasound is helpful in verifying the distal end of the fistula, we considered the tip of the probe must be the main guiding node in total resection. It is also interesting to note that in more than 90% of cases, this type of fistula appeared on the left,[ 1 2 3 4 5 ] whereas in our patient, the fistula was on the right side. Except the dominant side of the appearance of the fistula, we also witnessed that the leading reason does not have to be an infection or abscess, but aesthetics and leakage.…”

“…Although the articles mentioned computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of this anomaly, we considered the ultrasound to be optimal (given the age of the child), as confirmed by Hosokawa et al . [ 5 ] For visualization of cutaneous regions, sonography provides higher resolution images compared with CT or MRI. Unlike CT or MRI, sonographic examination of congenital anomalies does not involve radiation or require sedation, which carry small risks to infants and children.…”

Ultrasound Evaluation of Dermal Sinuses/Fistulas in Pediatric Patients

“…The sinus is usually narrow and short, and the distal side of the sinus is at the sternoclavicular joint. Therefore, US may show the whole length of the fistula extending into the sternoclavicular joint; this finding is important to enable complete resection . Other modalities are not usually needed for the evaluation.…”

“…Other modalities are not usually needed for the evaluation. In addition, the direction of the fistula is useful to differentiate it from other diseases with skin orifices, such as a congenital lateral cervical sinus/fistula . Complete resection is needed to prevent recurrence …”

“…In addition, color Doppler US without contrast enhancement is useful to differentiate a fistula from a vascular lumen . Determining the extent of the sinus's distal side is important for complete resection to prevent recurrence; US allows an accurate evaluation of the distal side …”