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. 2024 Jan;236(1):5-10.
doi: 10.1055/a-2151-2422. Epub 2023 Sep 7.

Ultrasonography in Children With Congenital Pyriform Sinus Fistula: Analysis of 31 Cases

Lei Liu  1 , Ruijie Wang  1 , Qiuying Zheng  1 , Fusui Xie  1 , Tingting Liu  1 , Zhouqin Lin  1 , Jingran Zhou  1 , Zebin Wu  2 , Cailei Zhao  3 , Haiyang Xie  1 , Zhou Lin  1
Affiliations

Ultrasonography in Children With Congenital Pyriform Sinus Fistula: Analysis of 31 Cases

Lei Liu et al. Klin Padiatr. 2024 Jan.

Abstract
in English, German

Objectives: Congenital pyriform sinus fistula (CPSF) is a rare disease that can be easily misdiagnosed. This study investigates the value of ultrasonography in the early diagnosis and treatment of CPSF in children.

Methods: Clinical features and ultrasonography images of 31 CPSF pediatric patients confirmed by operation were retrospectively analyzed, different sonographic features during the infection period and the quiescence period were summarized and the consistency test of ultrasonic recognition and diagnosis between observers was conducted.

Results: In this study, 25 CPSF children had thick-walled cystic masses during the infection period, and cystic masses of 8 cases showed gas echo inside; after the modified valsalva maneuver, gas echo was found in another 5 cases. The detection rate of gas can be enhanced through the modified valsalva maneuver and infants' cry so as to provide an important basis for the diagnosis of pyriform sinus fistula. During the quiescent period of inflammation of 6 cases, fistula can be completely shown, and the wall structure has not been completely destroyed, so that the running position of fistula can be clearly seen. Ultrasonography boasted a good inter-observer consistency in identification and determination (Kappa:0.799-0.857; P<0.001).

Conclusion: Ultrasonography could clearly reveal the position and direction of CPSF fistula. Different ultrasonic characteristics in different periods could provide relevant information for the selection of clinical operation timing and evaluate the post-operative effects.

Zielsetzung: Die kongenitale pyriforme Sinusfistel (CPSF) ist eine seltene Erkrankung, die leicht fehldiagnostiziert werden kann. In dieser Studie wird der Wert der Ultraschalluntersuchung bei der Frühdiagnose und Behandlung von CPSF bei Kindern untersucht.

Methoden: Klinische Merkmale und Ultraschallbilder von 31 pädiatrischen CPSF-Patienten, die durch eine Operation bestätigt wurden, wurden retrospektiv analysiert, verschiedene sonografische Merkmale während der Infektions- und der Ruhephase wurden zusammengefasst und der Konsistenztest der Ultraschallerkennung und -diagnose zwischen Beobachtern wurde durchgeführt.

Ergebnisse: In dieser Studie wiesen 25 CPSF-Kinder während der Infektionsperiode dickwandige zystische Massen auf, und die zystischen Massen von 8 Fällen zeigten ein Gasecho im Inneren; nach dem modifizierten Valsalva-Manöver wurde in weiteren 5 Fällen ein Gasecho gefunden. Die Gasnachweisrate kann durch das modifizierte Valsalva-Manöver und den Schrei des Säuglings erhöht werden, so dass sie eine wichtige Grundlage für die Diagnose der pyriformen Sinusfistel darstellt. In der Ruhephase der Entzündung kann in 6 Fällen die Fistel vollständig dargestellt werden, und die Wandstruktur ist nicht vollständig zerstört, so dass die Lauflage der Fistel deutlich zu erkennen ist. Die Ultraschalluntersuchung wies eine gute Übereinstimmung zwischen den Beobachtern bei der Identifizierung und Bestimmung auf (Kappa:0,799–0,857; P<0,001).

Schlussfolgerung: Mit Hilfe der Ultraschalluntersuchung konnte die Lage und Richtung der CPSF-Fistel eindeutig festgestellt werden. Unterschiedliche Ultraschallcharakteristika in verschiedenen Zeiträumen könnten relevante Informationen für die Auswahl des klinischen Operationszeitpunkts und die Bewertung der postoperativen Auswirkungen liefern.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Inflammatory infection period of pyriform fossa. Male, 10, made hospital visits with a mass on the left cervical area without obvious cause, accompanied with pain and fever for more than one month. ( a ). A non-homogeneous echo mass appeared on the left cervical area with poorly-defined border, and much liquid dark was noticed (arrow); ( b ). the mass was in an irregular tubular shape extending towards the pyriform fossa (arrow); ( c ). abundant blood flow signals were around the mass; ( d ). the anterior part of axial T1WI left carotid sheath was mixed with signal mass shadow, and retropharyngeal space was not clear; ( e ). the inferior part of coronal T2WI left inferior parotid gland was mixed with signal mass shadow, with poorly-defined border; ( f ). ltaryngoscopy suggested suspected fistula in the left pyriform fossa, with secretion on the surface.
Fig. 2
Fig. 2
Inflammation silent period of pyriform fossa. Male, 3 years and 9 months old, made hospital visits because of recurrent fever for 1 month. ( a ). The left cervical area showed strip parallel low echoes extending to the pyriform fossa, with clear boundaries (arrow); ( b ). no obvious blood flow signals were observed inside the strip parallel low echoes; ( c ). strip parallel low echoes went into the thyroid gland (arrow); ( d ). no obvious abnormality was found in the right pyriform fossa by the postoperative laryngoscope (arrow); ( e, f ). postoperative changes were discovered in the left pyriform fossa by the postoperative laryngoscope (arrow).
See this image and copyright information in PMC

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