Pyriform sinus rupture caused by blunt trauma.

Hypopharyngeal perforation (HP) is a potentially life-threatening condition most associated with iatrogenic injury and foreign body impaction. Additionally, a number of cases of posterior HP have been reported following blunt cervical trauma. We present a case of a construction accident causing lateral hypopharyngeal rupture. Visceral perforation was initially diagnosed on computed tomography (CT) imaging and managed conservatively. We speculate this region may be particularly vulnerable to injury due to an anatomic transition in adjacent fascial support. A review of 29 prior cases suggests that this may be the first reported case of blunt trauma causing rupture of the pyriform sinus. However, significant heterogeneity exists in diagnostic approach. Radiography and CT are rapid, sensitive modalities for suggesting pharyngeal perforation, while fluoroscopy and endoscopy can better assess injury size and location and monitor resolution. Early radiologic recognition of hypopharyngeal injury is essential to initiate appropriate treatment. In certain cases, including our own, both the presence and specific location of perforation may be identified on initial CT images.

A Lodged Barramundi Fish-Bone Stabbing the Piriform Fossa in a Child.

Unintentional ingestion of a fish bone is common in children, especially among families with high consumption of seafood. Complications in children are extremely rare. We describe a 3-year-old healthy boy who had a large bone of Barramundi fish lodged in his upper esophagus causing significant distress. Soft tissue neck radiograph revealed a mildly thickened epiglottis and bulbous and hypertrophied adenoid soft tissue. A 21-mm foreign body was noticed. A flexible fiberoptic laryngoscopy revealed a large fish bone emerging from the left piriform fossa and arcing over the left arytenoid to hover over the posterior glottis. The bone was removed during anesthesia induction before a rigid esophagoscopy. The fish-bone entry point was seen stabbing through the edge of the piriform fossa and running down alongside the esophagus, without causing a through and through perforation. Fish bone ingestion can cause significant complications including perforation of the esophagus. Early suspicion of ingestion, radiological investigation, and swift management are important to ensure reduced complication rate in children.

Tiroiditis agudas y abscesos cervicales como manifestaciones de las fístulas del seno piriforme / of the Acute thyroiditis and cervical abscesses as manifestationspyriform sinus fistulae

Las fístulas del seno piriforme son malformaciones poco frecuentes que causan abscesos cervicales recurrentes y tiroiditis agudas supurativas, cuya incidencia general es muy baja por la resistencia de la glándula tiroidea a la infección. El objetivo de este trabajo es describir la presentación clínica, diagnóstico, tratamiento y evolución de cuatro casos de fístulas del seno piriforme en niños tratadas en nuestro hospital en los últimos 15 años. Todos debutaron con tumoración inflamatoria laterocervical izquierda, con signos ecográficos de tiroiditis aguda supurativa en dos casos y con masas heterogéneas cercanas al its motiroideo en el resto. Las fístulas consiguieron ponerse de manifiesto conesofagogramas y/o fibrolaringoscopias. El tratamiento consistió en antibioticoterapia de amplio espectro y drenaje quirúrgico en la fase aguda, con posterior fistulectomía, asociando hemitiroidectomía izquierda en dos casos. Todos los pacientes permanecieron asintomáticos tras eltratamiento, a excepción de una niña con recidiva siete años después.Para realizar un adecuado diagnóstico se precisa un alto índice de sospecha. Hay que conseguir delimitar la fístula, siendo la mejor opción terapéutica la exéresis completa de la misma por un abordaje cervical hasta desconectarla de su origen en hipofaringe. Para evitar recidivas se recomienda la resección de la porción de la glándula tiroidea implicada (AU)

Pyriform sinus fistula is a rare malformation causing recurrent cervical abscesses and acute suppurative thyroiditis, with a low incidence in general, as the thyroid gland is remarkably resistant to infections. The aim of this paper is to describe the clinical data, diagnosis, treatment and evolution of four cases of pyriform sinus fistulas treated at our institution over the last 15-year period. All appeared at the beginning with left laterocervical inflammatory tumours, with radiological signs of acute suppurative thyroiditis in one case and with heterogeneous masses near the isthmus of the thyroid gland in the rest of them. The fistulous tracts were delineated by barium studies and/or fibro-laryngoscopy. The treatment of the acute phase consisted of broad-spectrum antibiotic therapy with an initial incision and drainage procedures. At the end, a subsequent fistulectomy was made. A left hemithyroidectomy was accomplished at two cases. All the patients remained asymptomatic after the treatment except one girl that suffered recurrence seven years later. For a suitable diagnosis a high index of suspicion are necessary. The best therapeutic option is a good delineation and complete excision of the fistulous tract by cervical approach until disconnecting it of its origin at the hypopharynx. In order to avoid recurrences, the resection of the portion of the involved thyroid gland is recommended (AU)