ガストログラフィン<sup>®</sup>嚥下後のCTが有用であった下咽頭梨状陥凹瘻例

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  • A Case of Pyriform Sinus Fistula Demonstrated on Computed Tomography after Gastrografin<sup>®</sup> Deglutition
  • リンショウ ガストログラフィンエンカ ゴ ノ CT ガ ユウヨウ デ アッタ シタ イントウ ナシジョウカンオウロウレイ

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The pyriform sinus fistula is a rare anomaly that derives from the third, fourth or fifth pharyngeal pouch, and may cause recurrent anterior neck abscesses and/or suppurative thyroiditis. A 16-year-old male presented with acute left anterior cervical swelling. Endoscopic examination showed pus pooling in the left pyriform sinus, and computed tomography (CT) revealed an irregular-shaped abscess in the left anterior cervical region. From these findings, a pyriform sinus fistula was suspected. The patient was treated with antibiotics, and the acute inflammation subsided temporarily. Videofluoroscopy and CT after gastrografin® deglutition were then performed. The latter clearly depicted the fistula arising from the left pyriform sinus extending down to the left thyroid lobe. The patient underwent transcervical resection of the fistula including a partial thyroidectomy. Immediately prior to resection, the fistula was stained by injecting crystal violet solution through the opening in the pyriform sinus using a curved laryngoscope. The fistula was readily identified intraoperatively by the injected stain, and successfully resected. The patient showed temporary vocal cord paralysis of the affected side, which recovered within 2 months after surgery. No recurrence has been seen in 8 months of follow-up. We would like to stress that CT combined with contrast medium deglutition is a powerful means to enable a definitive diagnosis of this anomaly and could thus be useful in planning a surgical procedure.<br>

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