Acute suppurative thyroiditis and the branchial apparatus

Acute suppurative thyroiditis and thyroid abscess are rare. The finding of a sinus tract arising from the pyriform sinus in some cases highlights the possibility of a branchial apparatus origin. We present three case histories that include a left-sided lesion and radiologic or surgical-anatomic evidence of an internal sinus tract. Our discussion focuses on two considerations: first, the exact branchial pouch from which this lesion arises, and second, a proposed protocol for the work-up and management of patients with the onset or recurrence of acute suppurative thyroiditis or thyroid abscess.