జర్నల్ ఆఫ్ ఒటాలజీ & రైనాలజీ

Case Report: Recurrent Thyroid Abscess Secondary to the Fistula of Pyriform Recess

Jos� Francisco de Sales Chagas, Jos� Luis Braga de Aquino, Maria Beatriz Nogueira Pascoal, Luis Antonio Brandi Filho, Fernanda Fruet, Douglas Rizzanti Pereira, Felipe dos Santos Silva and Gustavo dos Santos Silva

Case Report: Recurrent Thyroid Abscess Secondary to the Fistula of Pyriform Recess

Background: Acute suppurative thyroiditis is a rare event among the thyroid diseases, representing from 0, 1 to 0, 7% of the possible scenarios that can affect this organ. Pyriform recess fistula is the principal cause in children, presenting itself with an infectious process which is usually unilateral and recurrent. The authors report a case of a continuing thyroidal abscess due to pyriform recess fistula in a 16 year old patient, which is later than evidence describes.

Clinical Case: In 2009, patient, 14 years old caucasian male, present hyperemia and cervical edema, on the left side and toxiinfectious signs. The ultrasound showed dense collection at the topography of the left thyroid lobe, and the diagnosis was settled in suppurative thyroiditis; treatment was conducted accordingly, through surgical drainage and antibiotics. The infectious process recurred in the following years, and further investigation of the trigger factor showed that there was a fistulous route of the left pyriform recess, setting a fourth brachial arch persistence, leading to a left thyroidal lobectomy and resection of the fistulous route.

Discussion: as the main cause of suppurative thyroiditis in childhood, the pyriform recess fistula presents as an acute infectious process in an initial stage, and complementary exams will only show the consequences of this presentation, which are local collection and edema of adjacent structures, located in this case specifically more on the left side than the right. In the subacute stage of the disease, the diagnosis is determined through the pharyngo-esophagogram, which will reveal the fistulous tract, due to its contrast filling. The resection of the fistulous tract is the chosen surgical procedure, and it can partially resect the thyroid lobe or not.

Conclusion: the authors conclude that the pyriform sinus fistula is a rare disease and the leading cause of childhood suppurative thyroiditis as shown in the literature review, and therefore should be investigated in cases of suppurative thyroiditis and should be treated with a thyroidectomy with resection of the tract.