Adv Pediatr Surg.  2018 Dec;24(2):100-106. 10.13029/aps.2018.24.2.100.

Two Cases of Pyriform Sinus Cyst in Neonates: Importance of Early Recognition and Differential Diagnosis

• Chung MH
• Kim SY
• Lim GY
• Chung JH

• KMID: 2429807
• DOI: http://doi.org/10.13029/aps.2018.24.2.100

Abstract

Early suspicion is essential in diagnosing pyriform sinus cysts. We report two neonatal cases of pyriform sinus cysts presented as neck masses. The first case presented as a right neck mass, which made it more difficult to suspect a pyriform sinus cyst considering the prevalence of left sided cysts. Surgical resection was done in both cases and anatomical investigation suggested both to originate from the fourth branchial pouch. Detection of air bubble containing mass on imaging studies can aid early diagnosis and early use of gastric tube feeding can facilitate treatment by preventing milk contamination which may result in infection of the sinus cyst.

Keyword

Neonate; Branchial cleft cyst; Lymphangioma; Cystic; Diagnosis; Differential

MeSH Terms

Branchioma
Diagnosis
Diagnosis, Differential*
Early Diagnosis
Enteral Nutrition
Humans
Infant, Newborn*
Lymphangioma
Milk
Neck
Prevalence
Pyriform Sinus*

Figure

• 

  Fig. 1 (A) Ultrasound and (B, C) computed tomography images revealed a 3.6×6.5 cm sized elongated cystic mass, containing fluid level and air bubble (white arrow). (D) Fistulography shows a faintly opacified hairline tract (black arrows) originating from the right pyriform sinus.

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  Fig. 2 (A) Aspirated cystic fluid is yellowish and turbid and (B) the cyst is unilocular.

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  Fig. 3 (A) Neck anteroposterior view and (C, D) T2-weighted neck magnetic resonance imaging of cystic mass with air (white arrow). (B) Fistulography shows a faintly opacified hairline tract (black arrows) originating from the left pyriform sinus.

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  Fig. 4 Surgical dissection of pyriform sinus cyst and fistula (black arrow) ligation was done.

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