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Williams J, Abdul Wahab AH, Leman WI. Successful Treatment of a Thyroid Abscess in a Pediatric Patient: A Case Report. Cureus 2024; 16:e57428. [PMID: 38699091 PMCID: PMC11063414 DOI: 10.7759/cureus.57428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 05/05/2024] Open
Abstract
Thyroid abscess, or acute suppurative thyroiditis (AST), is an exceedingly rare condition, particularly in the pediatric population. It often results from congenital anomalies or is secondary to infections. Despite its rarity, prompt diagnosis and management are crucial to prevent serious complications. We report a case of a five-year-old girl with no significant medical history who presented with a two-week history of anterior neck swelling, odynophagia, fever, and leukocytosis. Notably, the patient did not exhibit symptoms of thyroid dysfunction. Initial treatment with antibiotics for a suspected bacterial infection at a private clinic did not lead to improvement. Ultrasound and computed tomography scans revealed a multiloculated abscess within the left thyroid lobe. The patient underwent successful incision and drainage, supported by antibiotic therapy, resulting in a full recovery without complications. Imaging studies played a critical role in diagnosing and guiding the management of this condition. Thyroid abscess, though rare, should be part of the differential diagnosis for pediatric patients presenting with acute neck swelling, fever, and pain. Early diagnosis and appropriate management, typically involving surgical drainage and antibiotics, are essential for a favorable outcome.
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Affiliation(s)
- Josiah Williams
- Department of Otolaryngology-Head and Neck Surgery, International Islamic University Malaysia, Kuantan, MYS
| | - Azwan Halim Abdul Wahab
- Department of Otolaryngology-Head and Neck Surgery, International Islamic University Malaysia, Kuantan, MYS
| | - Wan Ishlah Leman
- Department of Otolaryngology-Head and Neck Surgery, International Islamic University Malaysia, Kuantan, MYS
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Câmara B, Andrade C, Forno A, Lopes M, Pilar C. Acute Suppurative Thyroiditis in Childhood: An Atypical Presentation. Cureus 2024; 16:e55275. [PMID: 38562276 PMCID: PMC10982137 DOI: 10.7759/cureus.55275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Neck stiffness is a common clinical sign in children presenting to the emergency department that may indicate a wide variety of diagnoses. Acute suppurative thyroiditis (AST) is an infection of the thyroid gland caused by a bacterium, virus, or, less commonly, fungus. It presents as an acute or subacute development of an anterior cervical mass, with associated inflammatory signs. The pressure upon neck muscles may be reflected as a limitation of cervical mobility. AST is often preceded by an upper respiratory tract infection, and pyriform sinus fistula is the most common predisposing factor. It is particularly uncommon in the pediatric age, with limited cases reported in the literature. Therefore, a heightened suspicion is required for proper diagnosis and timely intervention, due to its high mortality. Prompt treatment with broad-spectrum parenteral antibiotic therapy and drainage is mandatory to prevent the numerous complications associated, namely, mediastinitis and sepsis. We report the case of a two-year-old female child admitted with a two-week history of intermittent high-grade fever and sore throat, followed by prostration and limitation in neck movement on admission. Examination revealed neck stiffness with positive Kernig and Brudzinski signs. The laboratory tests showed elevated inflammatory parameters. Cranial computed tomography (CT) scan and lumbar puncture were normal. On day 2 after admission, an anterior cervical mass with slight signs of fluctuation was detected. Ultrasound was compatible with a hemorrhagic/overinfected thyroid nodule, and the patient was started on broad-spectrum antibiotics. Due to clinical worsening, a cervical CT scan was performed, which documented a thyroid abscess with extension into the retropharyngeal space. She underwent surgical drainage, and Streptococcus anginosus and mixed anaerobes were isolated, sensitive to ongoing antibiotherapy. On multidisciplinary follow-up, an esophageal barium study, laryngoscopy, and cervical magnetic resonance imaging (MRI) were performed, revealing no anatomical defects. AST is a rare disease in children, but potentially fatal, so its early recognition and treatment are essential. We aim to draw attention to this disease and its differential diagnosis to reduce the associated morbimortality.
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Affiliation(s)
| | | | - Andreia Forno
- Pediatric Neurology, Hospital Dr. Nélio Mendonça, Funchal, PRT
| | - Marta Lopes
- Otolaryngology, Hospital Dr. Nélio Mendonça, Funchal, PRT
| | - Carla Pilar
- Pediatric Surgery, Hospital Dr. Nélio Mendonça, Funchal, PRT
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3
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Tian J, Cui P, Zhang H, Lv Z, Xu W. Endoscopic Suture With Chemocauterization: An Effective Treatment of Congenital Pyriform Sinus Fistula. Otolaryngol Head Neck Surg 2023; 169:1624-1630. [PMID: 37350304 DOI: 10.1002/ohn.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/31/2023] [Accepted: 04/29/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Endoscopic cauterization is an effective method for treating pyriform sinus fistula (PSF). However, these approaches sometimes result in a higher failure rate. We present an effective technique utilizing suture combined with chemocauterization as first-line treatment in patients with PSF and evaluate the safety and efficacy of its use in 126 patients. STUDY DESIGN Retrospective study. SETTING Tertiary referral center. METHODS Retrospective case review of patients treated between March 2012 and June 2021 at our institution with descriptive statistical analysis. RESULTS A total of 126 patients with PSF were included in this study with a mean age of 14.7 years. There was no sex predilection. The majority of patients presented with a left-sided neck lesion (89.7%). Ten patients presented following prior attempts at the surgery of the PSF at another institution; 8 via open surgery and 2 following endoscopic CO2 laser cauterization; other patients only had a history of repeat incision and drainage or antibiotic treatment. The success rate of obliteration of the internal opening was 96.83% after a single treatment without complications. Following reoperation, a successful outcome was achieved in the remaining 4 patients. Length of stay ranged from 10 to 14 days. No recurrences occurred within 12 to 120 months followed-up. CONCLUSION Endoscopic suture combined with chemocauterization is a safe and effective treatment of PSF. Surgery can be performed during the acute cervical inflammatory period without increased risk of complication or recurrence, however, patients found to have acute changes affecting the pyriform sinus should be treated with a staged surgery strategy.
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Affiliation(s)
- Jiajun Tian
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, Shandong, P.R. China
| | - Peng Cui
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, Shandong, P.R. China
| | - Haiyan Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, Shandong, P.R. China
| | - Zhenghua Lv
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, Shandong, P.R. China
| | - Wei Xu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, Shandong, P.R. China
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4
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Almoffarreh H, Alkaabi N, Alkhurayji A. Partially Treated Acute Suppurative Thyroiditis in a Healthy Child Caused by Streptococcus pyogenes. Cureus 2023; 15:e39227. [PMID: 37223343 PMCID: PMC10202661 DOI: 10.7759/cureus.39227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 05/25/2023] Open
Abstract
Thyroid abscess is a rare encounter due to its unique histological and structural features. It is usually associated with some form of congenital anomalies in pediatrics especially if recurred. Early recognition and treatment are of paramount importance in preventing complications. Atypical presentation can occur if the patient is improperly treated prior to presentation. Conservative management is becoming the mainstay of treatment unless there is a risk of airway compromise or extension. We report the case of a 15-month-old female who presented with anterior neck swelling. She received oral antibiotics prior to her visit and did not exhibit severe systemic illness despite her disease extension. She was found to have a thyroid abscess originating from the left thyroid lobe extending to the mediastinum. No congenital anomalies were found. She was managed with open drainage and her cultures grew Streptococcus pyogenes.
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Affiliation(s)
- Haitam Almoffarreh
- Pediatric Emergency Medicine, King Abdullah Specialist Children's Hospital, King Abdulaziz Medical City, Riyadh, SAU
| | - Nouf Alkaabi
- Pediatric Emergency Medicine, King Abdullah Specialist Children's Hospital, King Abdulaziz Medical City, Riyadh, SAU
| | - Abdullatif Alkhurayji
- Pediatric Emergency Medicine, King Abdullah Specialist Children's Hospital, King Abdulaziz Medical City, Riyadh, SAU
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5
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A Case of Pediatric Thyroid Abscess: A Rare Entity. Indian J Otolaryngol Head Neck Surg 2023. [PMCID: PMC9985088 DOI: 10.1007/s12070-023-03580-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
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McHan L, Gupta J. Thyrotoxicosis Due to Acute Suppurative Thyroiditis in a Pediatric Patient: A Case Report. J Investig Med High Impact Case Rep 2022; 10:23247096221127841. [PMID: 36245235 PMCID: PMC9575437 DOI: 10.1177/23247096221127841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Acute suppurative thyroiditis is a rare and potentially life-threatening cause of thyroid inflammation requiring prompt recognition and management. There are few reported cases of thyrotoxicosis due to acute suppurative thyroiditis. We are reporting the case of a 9-year-old boy who presented to the emergency room with fevers, neck pain and swelling, night terrors, and emotional lability. He was hemodynamically stable with initial lab work remarkable for neutrophilia without leukocytosis, elevated inflammatory markers, and hyperthyroidism. Imaging of the neck revealed a heterogenous collection in the region of the left thyroid concerning for suppurative thyroiditis and adenitis. He was admitted to the hospital and initiated on intravenous antibiotics. Given lack of significant improvement in pain, he was taken to the operating room for drainage on hospital day 4 with remarkable clinical improvement in pain. He was discharged on oral antibiotics. Lab work obtained on postoperative day 15 showed resolution of hyperthyroidism and decreasing inflammatory markers. Subsequent imaging following resolution of the acute illness did not reveal any anatomic abnormality that may have predisposed him to developing acute suppurative thyroiditis. Thyrotoxicosis as a complication of acute suppurative thyroiditis is a rare occurrence, and is thought to be due to the release of preformed thyroid hormone from damaged thyroid follicles. The thyrotoxic state is often transient and resolves with appropriate management of acute suppurative thyroiditis. This complication is important to recognize, as failure to appropriately diagnose and treat acute suppurative thyroiditis can lead to poor outcomes, such as airway compromise and death.
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Affiliation(s)
- Lara McHan
- University of Rochester Medical Center,
NY, USA,Lara McHan, Department of Pediatric
Endocrinology, Golisano Children’s Hospital, University of Rochester Medical
Center, 601 Elmwood Avenue, Box 777R, Rochester, NY 14642, USA.
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7
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Pereira KD, Highstein MJ, Greenwell AG, Isaiah A, Valdez TA. Suppurative Thyroiditis: A Management Paradigm Based on Microbiology. Pediatr Emerg Care 2021; 37:e1416-e1418. [PMID: 33003129 DOI: 10.1097/pec.0000000000002062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to determine if microbiological cultures can guide management of suppurative thyroiditis. DESIGN This study is a retrospective case series set in 2 tertiary care academic hospitals. METHODS The microbiological cultures from patients with suppurative thyroiditis who underwent incision and drainage from July 2004 to June 2018 were reviewed. Those who had confirmed pyriform sinus tracts and underwent surgical intervention were included in the study. RESULTS Fifteen patients satisfied the criteria for inclusion. All had confirmed pyriform sinus tracts and underwent successful intervention. Endoscopic cautery was the most common intervention followed by complete open excision. Five cultures grew alpha Streptococcus, 6 had Eikenella, and 4 Prevotella. Combinations of Eikenella + Prevotella were seen in 3, and 1 sample had all 3 bacteria. Two cultured methicillin-susceptible Staphylococcus aureus alone. One culture was sterile. CONCLUSIONS The presence of oral flora in an intrathyroidal abscess is confirmatory evidence of a pyriform sinus tract. Further investigations are not needed, and early definitive intervention can be planned.
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Affiliation(s)
| | | | | | - Amal Isaiah
- From the University of Maryland School of Medicine
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8
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Maksimoski M, Maurrasse SE, Purkey M, Maddalozzo J. Combination Surgical Procedure for Fourth Branchial Anomalies: Operative Technique and Outcomes. Ann Otol Rhinol Laryngol 2020; 130:738-744. [PMID: 33158383 DOI: 10.1177/0003489420971674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Branchial apparatus anomalies of the fourth cleft are the rarest subtype of anomaly and occasionally present with suppurative thyroiditis or thyroid abscess due to their relationship with the thyroid gland. Surgical approaches vary and some surgeons favor cauterization of associated pyriform sinus tracts alone versus complete surgical excision. Currently, the literature is scarce and there is limited data on surgical outcomes and procedural steps. Here we describe a combination surgical technique for fourth branchial anomalies including: (1) surgical excision of the cyst and any external pit, (2) hemithyroidectomy, and (3) direct laryngoscopy with cauterization of pyriform apex tract, if present. METHODS A retrospective review was performed on all patients who underwent surgical excision of fourth branchial apparatus lesions (including fistulae, cysts, and sinus tracts) at an urban pediatric university hospital from 2000 to 2019. Data regarding demographics, medical history, surgical methods, complications, and surgical cure rates were collected. RESULTS A total of 16 patients (9 female, 7 male) underwent a combination surgical procedure for fourth branchial apparatus lesions. Success rate after primary surgery was 94%. One patient had residual disease requiring re-operation. Two patients had post-operative complications: 1 transient vocal fold paresis and 1 seroma, both managed conservatively. A consensus surgical algorithm was created based on operative steps present in the majority of cases. CONCLUSION A combination approach to fourth branchial apparatus lesions-including endoscopic cauterization, external excision, and hemithyroidectomy-is safe and provides a high rate of primary cure. Although less invasive options exist, remnants of the branchial lesion, especially in the thyroid, may remain and cause recurrent issues. Therefore, we advocate for complete surgical excision of this rare developmental anomaly, especially when obvious thyroid involvement exists.
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Affiliation(s)
- Matthew Maksimoski
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah E Maurrasse
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Matthew Purkey
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John Maddalozzo
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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9
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Acute Bacterial Suppurative Thyroiditis following Fine Needle Aspiration: A Case Report and Review of the Literature. Case Rep Endocrinol 2020; 2020:7104806. [PMID: 32908721 PMCID: PMC7471785 DOI: 10.1155/2020/7104806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background Fine needle aspiration (FNA) of thyroid nodules is a simple, reliable, and inexpensive procedure performed on suspicious thyroid nodules found in thyroid ultrasound (US). Acute bacterial suppurative thyroiditis is an uncommon complication of FNA which, however, can be life threatening. Case Presentation. A 49-year-old lady presented with fever and neck pain 1 month after FNA with biochemical evidence of thyrotoxicosis. Repeat US of the thyroid showed interval enlargement of the thyroid nodule, and the culture of the cystic fluid of repeat FNA grew Propionibacterium acnes. She responded well to bedside aspiration and 2 weeks of antibiotic therapy without requiring surgical intervention. Discussion. Acute bacterial suppurative thyroiditis following FNA has been increasingly reported in immunocompetent hosts. There are 2 peculiar features in our case: a smoldering course caused by an indolent organism and a significant time lag between initial FNA and clinical presentation. On literature review, it was found that the onset of acute bacterial suppurative thyroiditis after FNA can range from a few days to up to 3 months. Clinicians should be aware of this complication even if FNA has been performed a few months ago. Thyroid US and US-guided FNA are useful initial investigations. Conventional management of acute bacterial suppurative thyroiditis has been surgery combined with antimicrobial therapy. However, recently, a more conservative approach has been reported to be effective in the treatment of acute bacterial suppurative thyroiditis as well. Conclusion Proper infection control practices are necessary in performing the FNA. Initial management (conservative versus surgical) of acute bacterial thyroiditis should be based on the patient's clinical status and the extent of infective focus.
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10
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Thyroid abscess secondary to pyriform sinus fistula. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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11
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Lhamu U, Wassner AJ, Topor LS. COINCIDENT SUPPURATIVE THYROIDITIS AND GRAVES DISEASE IN A PATIENT WITH INFECTED BRANCHIAL CLEFT CYST. AACE Clin Case Rep 2020; 5:e365-e368. [PMID: 31967072 DOI: 10.4158/accr-2019-0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/17/2019] [Indexed: 11/15/2022] Open
Abstract
Objective Acute suppurative thyroiditis (AST) is frequently caused by anatomic abnormalities, including branchial cleft cysts. Patients with AST are typically euthyroid, but thyrotoxicosis may occur. Thyroid antibodies are usually not present in AST. Our objective is to describe a teenage male who presented with concomitant suppurative thyroiditis and Graves disease (GD). Methods We report a case of an infected left branchial cleft cyst with AST and concurrent GD in an adolescent male. Thyroid function tests and thyroid imaging were used for diagnostic evaluation, and the patient was managed with antibiotics, analgesia, and surgery. Results A 17-year-old male with a history of an infected left fourth branchial cleft cyst presented with recurrence of neck pain, odynophagia, and fever. Serum labs showed thyrotoxicosis and elevated thyroid antibodies and inflammatory markers. Magnetic resonance imaging showed an abscess adjacent to the left thyroid lobe. Symptoms resolved after antibiotic therapy, but laboratory tests showed persistent subclinical thyrotoxicosis. Four months later, he underwent excision of the branchial cleft cyst and left thyroid lobe. Two months after surgery, evaluation showed overt thyrotoxicosis with laboratory tests confirming GD. Methimazole was initiated and thyroid function subsequently normalized. Conclusion This patient manifested a rare coincidence of AST due to a branchial cleft cyst and autoimmune thyroid disease. Further studies are needed to determine if there is any relationship between AST and development of thyroid autoimmunity. Assessment of thyroid autoimmunity may be considered in patients with prior or recurrent AST.
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12
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Derks LSM, Veenstra HJ, Oomen KPQ, Speleman L, Stegeman I. Surgery versus endoscopic cauterization in patients with third or fourth branchial pouch sinuses: A systematic review. Laryngoscope 2015; 126:212-7. [PMID: 26372400 DOI: 10.1002/lary.25321] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To systematically review the current literature on treatment of third and fourth branchial pouch sinuses with endoscopic cauterization, including chemocauterization and electrocauterization, in comparison to surgical treatment. DATA SOURCES PubMed, Embase, and the Cochrane Library. REVIEW METHODS We conducted a systematic search. Studies reporting original study data were included. After assessing the directness of evidence and risk of bias, studies with a low directness of evidence or a high risk of bias were excluded from analysis. Cumulative success rates after initial and recurrent treatments were calculated for both methods. A meta-analysis was conducted comparing the success rate of electrocauterization and surgery. RESULTS A total of 2,263 articles were retrieved, of which seven retrospective and one prospective article were eligible for analysis. The cumulative success rate after primary treatment with cauterization ranged from 66.7% to 100%, and ranged from 77.8% to 100% after a second cauterization. The cumulative success rate after the first surgical treatment ranged from 50% to 100% and was 100% after the second surgical attempt. Meta-analysis on electrocauterization showed a nonsignificant risk ratio of 1.35 (95% confidence interval: 0.78-2.33). CONCLUSIONS The effectiveness of cauterization in preventing recurrence seems to be comparable to surgical treatment. However, we suggest endoscopic cauterization as the treatment of choice for third and fourth branchial pouch sinuses because of the lower morbidity rate.
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Affiliation(s)
- Laura S M Derks
- Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery, Utrecht, the Netherlands
| | - Hidde J Veenstra
- Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery, Utrecht, the Netherlands
| | - Karin P Q Oomen
- Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery, Utrecht, the Netherlands
| | - Lucienne Speleman
- Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery, Utrecht, the Netherlands
| | - Inge Stegeman
- Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery, Utrecht, the Netherlands.,Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
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13
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Josephson GD, Black K. A Review Over the Past 15 Years of the Management of the Internal Piriform Apex Sinus Tract of a Branchial Pouch Anomaly and Case Description. Ann Otol Rhinol Laryngol 2015. [PMID: 26215722 DOI: 10.1177/0003489415593554] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Literature review of treating the piriform apex sinus tract through microlaryngoscopy and a case description. REVIEW METHODS Fourteen papers were identified in PubMed using the search criteria of piriform sinus fistula, microlaryngoscopic repair, and endoscopy. Institutional Review Board approval was obtained. RESULTS One hundred forty-five cases including ours were available for review, with 182 procedures. Sixty-two cases were male, 73 female, and 10 genders were not reported. Multiple treatment options were used, including electrocautery, chemocautery, mass excision, fibrin glue, lasers, suture closure, or combination of stated modalities. Of the 182 procedures, 147 procedures were performed endoscopically. There were 37 recurrences (25%). These patients either underwent a repeat endoscopic procedure or an open excision. One hundred and ten (75%) endoscopic procedures were successful. CONCLUSIONS Piriform sinus tract anomalies often present as a mass and recurrent neck infections. This review reveals that treating the internal piriform sinus opening alone can be successful. This procedure has low morbidity, short operative time, and high success. We advocate this approach first with a combined open/laryngoscopic approach for failed cases. To our knowledge, our technique of CO₂laser ablation of the tract followed by suture closure has not been previously described. We believe this to be the first comprehensive review of this topic and the largest series of cases included in a single report.
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Affiliation(s)
- Gary D Josephson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Nemours Children's Clinic Jacksonville, Florida, USA
| | - Kaelan Black
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida, USA
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14
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Broadney M, Senguttuvan R, Patel PG. Case 3: anterior neck swelling, fever, and hypertension in a 3-year-old boy. Pediatr Rev 2015; 36:178-80. [PMID: 25834223 PMCID: PMC4571920 DOI: 10.1542/pir.36-4-178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Miranda Broadney
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Rajan Senguttuvan
- Section of Pediatric Endocrinology, Department of Pediatrics, College of Medicine, The University of Arizona, Tucson, AZ
| | - Priti G Patel
- Pediatric Endocrinology, Texas Tech University Health Sciences Center, El Paso, TX
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15
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Parida PK, Gopalakrishnan S, Saxena SK. Pediatric recurrent acute suppurative thyroiditis of third branchial arch origin--our experience in 17 cases. Int J Pediatr Otorhinolaryngol 2014; 78:1953-7. [PMID: 25219934 DOI: 10.1016/j.ijporl.2014.08.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 07/29/2014] [Accepted: 08/24/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe clinical presentations, management and treatment outcomes of 17 cases of congenital pyriform sinus fistula (PSF) of third branchial arch origin presenting as left recurrent acute suppurative thyroiditis with cervical abscess. METHOD Medical record of these 17 cases (5-males, 12-females) presented during 2009-2013 were reviewed. RESULTS Average age was 9.6 years (range 3-15 years). Fistulous opening in neck was present in 10 cases (58.8%). Average number of episode of infection from first presentation to definitive diagnosis was 3 (range 2-5). All patient had history of incision and drainage (ID) of abscess (average 2, range 1-3). All cases had barium swallow and CT scan. Sixteen cases had telescopic hypopharyngoscopy. Barium swallow and telescopic hypopharyngoscopy detected PSF in 88.23% (15/17) and 100% (16/16) cases respectively. Fourteen cases were treated by transcervical excision (TE) (fistulectomy with left hemithyroidectomy), two cases were treated by endoscopic chemical cauterization (ECC) of internal opening at pyriform sinus using silver nitrate and only ID of abscess was done in one case. Success rate of TE and ECC was 93% and 100% respectively. Recurrence in one case initially treated by TE was managed successfully by ECC. CONCLUSION Presence of congenital PFS should be suspected when left-sided intra-thyroidal abscess formation occurs as gland is resistant to infection. Strong clinical suspicion, barium swallow study, telescopic pharyngoscopy and CT scan are the key to diagnosis. Both TE and ECC has comparable success rate. ECC may prove a useful and equally effective method of treatment for congenital PFS in future.
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Affiliation(s)
| | | | - Sunil Kumar Saxena
- Department of Otorhinolaryngology and Head-Neck Surgery, JIPMER, Puducherry, India
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16
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Sayyahfar S, Nasiri SJ. First report of a thyroid abscess in the pediatric age group caused by Arcanobacterium haemolyticum. J Infect Chemother 2013; 18:584-6. [PMID: 22286406 DOI: 10.1007/s10156-011-0349-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 11/14/2011] [Indexed: 11/29/2022]
Abstract
Thyroid abscess is a rare event especially in the pediatric age group. We report a 2-year-old girl with thyroid abscess who presented with fever and an anterior painful neck mass. Culture of the aspirated fluid yielded Arcanobacterium haemolyticum, which is one of the etiologies of pharyngitis and rash in children and, especially, young adults. As far as we are aware this is the first report of thyroid abscess in the pediatric or adult age group caused by Arcanobacterium haemolyticum.
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Affiliation(s)
- Shirin Sayyahfar
- Department of Pediatric Infectious Diseases, Ali Asghar Children Hospital, Tehran University of Medical Sciences, Vahid Dastgerdi Street, Shariati Street, Tehran 1919816766, Iran.
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Céspedes C, Duran P, Uribe C, Chahín S, Lema A, Coll M. Thyroid abscess. A case series and literature review. ACTA ACUST UNITED AC 2012. [PMID: 23177094 DOI: 10.1016/j.endonu.2012.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Thyroid abscess is rare in children but the presence of previous thyroid disease, and congenital remnants such as a pyriform sinus fistula, are predisposing factors. The classical presentation consists of fever, cervical pain and a painful mass. The diagnosis is confirmed through clinical findings, and by diagnostic imaging (ultrasound and computerized axial tomography). A barium swallow must be performed in order to detect a fistula and to consider surgical drain. We present the cases of thyroid abscess in five patients who were admitted in four medical centers (Fundación Cardioinfantil, Hospital Universitario San Ignacio, Clínica infantil de Colsubsidio and Hospital de la Misericordia) in Bogotá, Colombia between 2000 and 2010.
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Affiliation(s)
- Camila Céspedes
- Unidad de Endocrinología Pediátrica, Hospital Universitario San Ignacio, Departamento de Pediatría, Universidad Javeriana, Bogotá, Colombia.
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Wongphyat O, Mahachoklertwattana P, Molagool S, Poomthavorn P. Acute suppurative thyroiditis in young children. J Paediatr Child Health 2012; 48:E116-8. [PMID: 21535286 DOI: 10.1111/j.1440-1754.2011.02075.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report two children with acute suppurative thyroiditis (AST). They presented with typical features of AST, which include fever, painful goiter and biochemical euthyroidism. An anatomical defect predisposed to thyroid infection, pyriform sinus fistula, was identified in one patient. Both patients responded well to surgical pus drainage and antibiotic treatment. Anatomical defects must be sought in all children with AST to perform specific surgical treatment and prevent recurrent infection.
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Affiliation(s)
- Oranan Wongphyat
- Departments of Pediatrics Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Paes JE, Burman KD, Cohen J, Franklyn J, McHenry CR, Shoham S, Kloos RT. Acute bacterial suppurative thyroiditis: a clinical review and expert opinion. Thyroid 2010; 20:247-55. [PMID: 20144025 DOI: 10.1089/thy.2008.0146] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Acute suppurative thyroiditis (AST) resulting from a bacterial infection is an infrequent but potentially life-threatening endocrine emergency. Traditional management of this disease has been surgery in conjunction with targeted antibiotic therapy. Recent nonrandomized reports of small series have demonstrated good outcomes using less invasive approaches. No randomized clinical trials have been performed. Here, we provide a review of the literature and an approach to this problem based on expert opinion. METHODS The literature was reviewed utilizing PubMed, and a representative case of AST was presented to a panel of experts. Endocrinology, surgery, and infectious disease experts responded to a series of questions regarding diagnosis, management, prognosis, and harm. RESULTS Combining a broad spectrum of clinical expertise and the published literature, the authors suggest a clinical algorithm as a guide to management, addressing both diagnosis and acute and long-term management. CONCLUSIONS Published studies indicate a trend toward less invasive management during active inflammation and infection and regarding definite therapy. Remaining questions are presented to foster an evidence-based approach to this disease. Ideally, future randomized, controlled trials will provide data to improve the therapy and outcome of AST.
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Affiliation(s)
- John E Paes
- Endocrinology, Diabetes, and Metabolism Feedback Consulting, LLC and Westerville Medical Associates Central Ohio Primary Care Physicians, Inc., Westerville, Ohio 43081, USA.
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