Imaging of Congenital Subclavian Artery to Subclavian Vein Fistula in a Newborn.

The purpose of this paper is to report a congenital subclavian artery to subclavian vein fistula in a three weeks old male infant who presented with congestive heart failure and pulmonary hypertension. He had been scanned by various imaging modalities including echocardiography, cardiac computed tomography, diagnostic cardiac catheterization, cardiac magnetic resonance angiocardiography and cranial computed tomoangiography. He had successful surgical ligation after failure of device occlusion trial at age of 9 months.

Repeated Infection and Inflammation in a Case with Bilateral Congenital Lacrimal Fistula after Complete Fistulectomy

PURPOSE: To report a case of bilateral congenital lacrimal fistula that presented with repeated infection and inflammation after complete fistulectomy, which required an incision and drainage of pus from the operation site. CASE SUMMARY: A 22-year-old male without any medical history presented with repeated erythematous swelling and inflammation, resulting in tenderness around the opening of congenital lacrimal fistula. The lacrimal fistula opening was located approximately 12 mm inferiorly apart from the medial canthus. The complete excision of lacrimal fistula was performed without any inter-operative events. However, 4 days postoperatively, the patient complained of discomfort and swelling, with purulent discharge from the bilateral operation site. There was no improvement although treatment with antibiotics, incision and drainage was performed. After 1 month, an additional incision and drainage was necessary due to inflammation in the left operation site. One month later, pus and purulent discharge were occurring from the right operation site, requiring an additional incision and drainage. At that time, Actinomyces israelli was identified on wound culture examination. One month later, an additional incision and drainage was performed due to repeated inflammation in the left operation site. In the present case, we hypothesized the opening site of congenital lacrimal fistula was relatively far apart from the medial canthus and played a role in atypical repeated inflammation and infection on the operation site. CONCLUSIONS: In surgical treatment of congenital lacrimal fistula, careful preoperative observation of the location of the lacrimal fistula's opening site would be helpful in prediction of postoperative complication, such as wound infection and inflammation, as well as in educating and informing the patient.

A Case of Congenital Midline Fistula of the Lower Lip

PURPOSE: Congenital midline upper lip sinus is a rare lesion. There are two postulates that can account for the formation of the upper lip sinus based on two major theories of the development of the face: the fusion theory and the merging theory. However, congenital midline lower lip sinus is very rarely reported and described. We report a case of a congenital midline sinus of the lower lip in a 6-year-old female. METHODS: A 6-year-old girl presented with a nipple like swelling on the midline lower lip. Physical examination revealed about 5x5mm protruding round mass with a just small opening that was non-tender to palpation. The mass was not associated with any skin changes. It umbilicated at the apex and contains a fistulous tract, discharging clear fluid. Only, simple radiologic finding shows bony spur on the lower one third of mandibular symphsis. RESULTS: A small transverse ellipse is made around the opening and elevated mass with sharpe dissection. The tract is excised using the probe and dye as the guide. The tract was extended to periosteum of the lower one third of the mandible. The tract and involved periosteum were excised en bloc, and removed protrusion of the mandibular bone using diamond burr. Microscopic examination of the resected sinus revealed the fistulous tract itself, consisting of fibrous connective tissue covered with cornified stratified squamous epithelium, was observed in the center of the sample. In 6 months follow-up, This patient had a good result was obtained by the method of fistulectomy alone. CONCLUSION: Midline cranoifacial fistulas represent rare lesions resulting from abnormal fusion of embryologic structures. Our case report describes the excision of a congenital midline sinus of the lower lip in a 6-year-old female. This case represents the first report of a lower lip sinus presenting in a girl as a mass in the skin of the chin with extension to the midline of the mandible. However, the etiology of this rare congenital sinus remains obscure.

Radiologic Findings of a Recurrent Thyroidal and Perithyroidal Soft Tissue Infections Associated with a Pyriform Sinus Fistula: A Case Report / 대한내분비외과학회지

We report here on a case of a recurrent left anterior neck infection and focal left suppurative thyroiditis that were associated with a congenital pyriform sinus fistula (PSF) in an 18-year-old male. Acute suppurative thyroidits is a very rare clinical condition and it is usually caused by infection that's derived from infected perithyroidal tissue or a congenital internal fistula. The PSF can lead to recurrent episodes of neck inflammation and abscess, and it is the most common cause of acute suppurative thyroiditis in young man. In this current case, the CT scan showed an air-containing tract of a PSF from the left pyriform sinus to the left thyroid gland and the perithyroidal soft tissue. The CT scan also showed a neck inflammatory infiltration or abscess along the course of the sinus tract. The focal low density of the thyroid parenchyma was seen and this was suggestive of suppurative thyroiditis. Barium esophagography demonstrated the fistulous tract in the PSF. We performed laryngoscopy, and the internal opening of the pyriform sinus fistula was successfully cauterized with AgNO3 and the post procedure course was fair. When an air-containing tract and a recurrent inflammatory infiltration or abscess are present at the left anterior neck with including the thyroid and perithyroidal soft tissue, a PSF should be strongly suspected.