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Case Reports
. 2012:2012:934968.
doi: 10.1155/2012/934968. Epub 2012 Jan 22.

Right-sided pyriform sinus fistula: a case report and review of the literature

Rachel B Cain  1 , Peter Kasznica, William J Brundage
Affiliations
Case Reports

Right-sided pyriform sinus fistula: a case report and review of the literature

Rachel B Cain et al. Case Rep Otolaryngol. 2012.

Abstract

Objectives. Pyriform sinus fistulae arise from disturbances in the development of the fetal third and fourth branchial pouches and are predominantly found on the left side. We report the rare case of a right-sided pyriform sinus fistula presenting as a lateral neck abscess. Study Design. Case report. Methods. A 24-year-old woman presented with a two-week history of right-sided neck abscess. A fluoroscopic sinogram revealed a fistulous tract extending from the abscess to the apex of the right pyriform sinus. It was determined that the fistula was likely a third or fourth branchial remnant, a rare right-sided finding. Chemocauterization of the fistulous tract with 40% trichloroacetic acid was used to successfully treat the patient. Results. Approximately 93-97% of branchial pouch anomalies are left sided. Treatment options include surgical excision and cauterization. Conclusions. Branchial cleft cyst and pyriform sinus fistula must be considered in the diagnosis of cervical abscess in either side of the neck.

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Figures

Figure 1
Figure 1
Fluoroscopic sinogram of pigtail catheter drain in the right lateral neck. (a) Anteroposterior view depicting pigtail catheter placed in the right cervical abscess. (b) Oblique view shows contrast exiting catheter and flowing into a fistulous tract leading to (c) the apex of the right pyriform sinus. (d) Lateral view.
Figure 2
Figure 2
Fistulous tract (arrow) visualized in the right pyriform sinus adjacent to esophagus (arrowhead).
Figure 3
Figure 3
Right pyriform sinus fistulous tract cannulated with straight laryngeal probe (arrow).
Figure 4
Figure 4
Laryngeal forceps used to insert TCA-soaked micropledget into fistulous tract.
Figure 5
Figure 5
Ablated fistulous tract after cauterization with 40% TCA.
Figure 6
Figure 6
Esophagram (anteroposterior and lateral views) of cervical esophagus with barium swallow demonstrating a slight widemouthed outpouching of the right hypopharynx without contrast pooling. There is absence of a fistulous tract.
See this image and copyright information in PMC

References

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