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Fourth branchial pouch sinus - an unusually late initial presentation.

Indranil Pal¹, Subhabrata Sengupta, R Balakrishnan

¹Department of ENT & HNS, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India.

Indian Journal of Otolaryngology and Head and Neck Surgery : Official Publication of the Association of Otolaryngologists of India

|November 3, 2012

Summary

A rare 4th branchial pouch sinus case presented as pseudothyroiditis in a 20-year-old male. This study highlights that branchial pouch sinuses can present later in life, even without a history of recurrent infections.

Keywords:

4th branchial pouch pseudothyroiditis

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Area of Science:

Otolaryngology
Pediatric Surgery
Medical Case Reports

Background:

4th branchial pouch sinus is a rare congenital anomaly.
Typically presents in early childhood, often with recurrent neck infections.
Misdiagnosis is common due to varied presentations.

Purpose of the Study:

To report an unusual case of 4th branchial pouch sinus presenting late in life.
To review the literature on 4th branchial pouch sinus.
To emphasize the importance of considering this diagnosis in atypical presentations.

Main Methods:

A case report of a 20-year-old male with 4th branchial pouch sinus.
Diagnostic methods included radiology and endoscopy.
Surgical treatment was performed.
A comprehensive review of the world literature was conducted.

Main Results:

The patient presented with pseudothyroiditis, mimicking thyroid inflammation.
Histopathology confirmed chronic inflammatory changes, indicating subclinical inflammation.
The condition remained occult until age 20 due to low-grade, recurrent inflammation.

Conclusions:

4th branchial pouch sinus can present beyond the first decade of life.
Subclinical inflammation or infections can mask the condition.
The diagnosis should be considered even in the absence of a history of recurrent neck infections.