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Occult congenital pyriform sinus fistula causing recurrent left lower neck abscess
1Department of Otolaryngology, Taipei Medical College, 252 Wu-Hsing Street, Taipei,110, Taiwan.
Background:
Congenital pyriform sinus fistula (CPSF) is a rare branchial pouch anomaly; it has the characteristic of left-sided predominance and is not always detected until complications such as neck abscess or acute suppurative thyroiditis resulted.
Method:
Seven sequential cases of CPSF, including five adults and two children, causing recurrent left lower neck abscess were reported. All of these patients had past histories of misdiagnosis: the intervals from the onset of symptoms to correct diagnosis ranged from 3 years to 34 years with an average of 20 years.
Results:
After barium swallow study and direct laryngoscopic examination in the quiescent stage of infection, the CPSFs of these seven patients were successfully excised with or without catheter guide.
Conclusion:
The key to diagnosis of CPSF is a high index of suspicion by the clinician. CPSF should be considered in the differential diagnosis of a neck abscess, especially if it is recurrent and left-sided.