Routes of infection of acute suppurative thyroiditis diagnosed by barium examination

A fistula between the left pyriform sinus and the left thyroid gland region has been reported to be the route of infection in several cases of acute suppurative thyroiditis. Another four patients with acute suppurative thyroiditis have been encountered in whom a fistula from the hypopharynx was demonstrated radiographically. In three patients the fistulous tract was situated on the right side, and in one of these cases the fistula originated from the epiglottic vallecula rather than the pyriform sinus. These locations have not been reported earlier. Endoscopic examination was valuable for confirming the diagnosis.     

CT imaging and fourth branchial pouch fistula in adults

We report two cases of fourth branchial pouch in adult. This rare and little-known pathology is indeed responsible for suppurative thyroiditis and left lower cervical abscess recurring in spite of antibiotic treatment and incision-drainage. CT scan using, iv contrast, air as a agent contrast with Valsalva test, shows air in the thyroid and perithyroid soft tissue infection, proving communication between the pyriform fossa and the thyroid. Bubble of air behind the left thyroid alar in the sinus track is the best argument for diagnosis. Hypopharyngoscopy shows the mucous opening of the bottom at the pyriform sinus.     

Relapsing suppurative neck abscess after chemocauterization of pyriform sinus fistula

We report a case of relapsing suppurative neck abscess due to a pyriform sinus fistula ever treated by chemocauterization. Pyriform sinus fistula is rare, and chemocauterization is an alternative microinvasive procedure. This case indicates that the possibility of recurrence following management of chemocauterization exists even after a long time and that clinical radiological assessments are necessary.     

An unusual cause of recurrent pediatric neck abscess: pyriform sinus fistula

We present a case of recurrent anterior neck abscess due to a congenital fourth branchial anomaly. Pyriform fossa sinus is uncommon and poses a diagnostic and therapeutic challenge. This case reiterates that any child with a recurrent anterior neck mass should undergo thorough clinical and radiological assessments to rule out the possibility of a congenital sinus/fistula.     

Acute suppurative thyroiditis secondary to piriform sinus fistula:: a case report

We present a typical case of acute suppurative thyroiditis (AST), associated with a piriform sinus fistula. We illustrate the case with an ultrasound picture of a hypoechogenic perithyroid mass and a CT scan using intravenous iodine contrast showing a perithyroid hypodense mass with peripheral enhancement, the mass also having intrathyroid involvement. When clinical and radiological findings suggest the presence of AST, it is necessary to rule out the presence of a piriform sinus fistula by means of a radiological study with barium contrast. Piriform sinus fistula is a rare abnormality derived from the branchial arch which is directly related to recurrent episodes of AST; surgical excision is hence, necessary to avoid such episodes.     

Clinical usefulness of multidetector CT fistulography of branchial cleft fistula

We report three cases of branchial cleft anomalies demonstrated by multidetector computed tomography (MDCT) fistulography. Multiplanar reformatted images using MDCT were excellent in delineating the whole fistulous tract and its surrounding structures. MDCT fistulography was very helpful in the diagnosis and surgical planning for sinus and fistula of branchial cleft anomalies.     

Branchial fistula arising from pyriform fossa: CT diagnosis of a case and discussion of radiological features

Anomalies of third or fourth branchial apparatus origin are very uncommon and present as recurrent neck infections or thyroiditis with a predominant left-sided involvement. Radiological diagnosis requires a high index of suspicion and is critical for initiation of proper treatment. We describe a case of branchial sinus of pyriform fossa with external fistulization that presented in adulthood and was diagnosed on computed tomographic scan. The radiological features of this rare anomaly are revisited.     

先天性梨状窝瘘的放射学诊断及初步分型

目的：探讨食管钡剂造影和CT扫描对先天性梨状窝瘘管临床诊断和分型的价值。方法：经手术证实的先天性梨状窝瘘患儿36例。回顾性分析其术前食管钡荆造影和/或颈部CT扫描的影像学资料,并结合手术病理结果,对其进行分型。结果：36例中,27例术前行食管钡剂造影检查者,其中25例出现梨状窝形态异常、窦道形成、窦道合并末端窦腔等征象...     

Typical MR imaging findings of perianal infections in patients with hematologic malignancies

ObjectiveWe aimed to investigate the MR imaging findings of patients with hematologic malignancies who have symptoms suggesting perianal infection and to demonstrate the importance of imaging.Subjects and methodsThe study included 36 patients with hematologic malignancies who underwent anorectal MR imaging in our department between September 2011–May 2016. Two radiologists experienced in abdominal radiology viewed the MR images in consensus. Abscesses, fistulous or sinus tracts, signal alterations and contrast enhancement in keeping with an inflammation and edema in the perianal region were recorded.ResultsPerianal abscess was found in 16 of the 36 patients. In 10 of these 16 patients there was also extensive inflammatory signal alterations in perianal and/or perineal soft tissues.In six of the 36 patients perianal fistula was detected. A sinus tract was seen at the level of subcutaneous external anal sphincter in one patient. Inflammatory signal alterations in the surrounding soft tissues were present in three of these seven patients.There were abscesses in labium majus in two patients and in one patient there were perineal abscesses with accompanying inflammatory signal alterations.In six of the 36 patients no abscess or fistula/sinus tract was seen. There were only inflammatory signal alterations with contrast enhancement in perianal or subcutaneous tissues.In two patients presenting with perianal pain and hemorrhoids, minimal inflammatory changes were detected on MR images.There were two patients with normal MR imaging findings.ConclusionAs digital examination of the anorectum and rectoscopy are avoided in neutropenic patients, MR imaging, which clearly demonstrates the perianal pathology should be preferential.     

CT of abdominal abscess with fistulous communication to the gastrointestinal tract

We review CT of 24 cases of intraabdominal abscess with fistulous communication to the GI tract confirmed by GI contrast study or fistulogram. Underlying causes of fistulization included recent GI tract surgery (13), diverticulitis (four), unknown etiology (three), malignant neoplasm (two), trauma (one), and pancreatitis (one). Thirteen (54%) abscesses showed air-fluid levels, 14 (58%) showed air bubbles, and seven (29%) showed both. Bowel contrast material was administered in 21 cases, and optimal bowel opacification was effected in 16. However, contrast extravasation into the abscess was noted in only six cases. We conclude that an air-fluid level may indicate the presence of a fistulous communication to the GI tract, but its absence does not necessarily mean there is no communication. Also, recognition of contrast within the abscess is uncommon even with optimal bowel opacification. In cases of clinical suspicion of internal fistula, a fistulogram or GI contrast study should be performed.     

鳃裂囊肿的MRI和CT诊断

目的：讨论鳃裂囊肿的ＭＲ和ＣＴ表现及其诊断价值。方法：对均经手术和病理证实的１１例鳃裂囊肿病人（第一鳃裂囊肿２例,第二鳃裂囊肿９例）的ＣＴ或ＭＲＩ的表现进行分析,并结合文献进行讨论。结果：第一鳃裂囊肿表现为耳前区反复感染或瘘,其特征为瘘道与外耳道平行;第二鳃裂囊肿常表现为颈外侧部和颌下区无压痛囊性肿块,ＣＴ和ＭＲＩ表现为薄壁、均质的囊性肿块,胸锁乳突肌受压向后外或向后移位,颈动脉间隙大血管向内或向     

Actinomycosis: CT findings in six patients

Actinomycosis is an uncommon disease with clinical and radiographic findings that overlap those of other inflammatory and neoplastic conditions. A retrospective review of CT scans in six proved cases revealed a spectrum of findings, including soft-tissue mass with various degrees of infiltration and abscess formation. Administration of IV contrast material was helpful in defining the loculations of the abscess in two cases. Areas of involvement included the neck (two cases), liver (one case), abdominal wall (one case), thorax (one case) and kidney and retroperitoneum (one case). CT findings of a soft-tissue mass in the neck, lungs, or abdomen, with or without a draining sinus or fistula, raise the possibility of actinomycosis in patients with clinical findings that suggest a subacute or chronic inflammatory process.     

Correlation of local outcome after partial laryngectomy with cartilage abnormalities on CT

BACKGROUND AND PURPOSE: The prognostic significance of laryngeal cartilage abnormalities, as seen on CT or MR imaging, in laryngeal or hypopharyngeal cancer, is unclear. The purpose is to determine whether cartilage abnormalities as seen on preoperative CT in laryngeal and pyriform sinus cancer are predictive of local outcome after partial laryngectomy. METHODS: The preoperative CT studies in a consecutive series of 16 patients who underwent extended hemilaryngectomy for squamous cell carcinoma of the glottis (n = 12), supraglottis (n = 1), or pyriform sinus (n = 3) were reviewed retrospectively. Cartilage abnormalities were defined as asymmetric cartilage sclerosis, lysis of ossified cartilage, or tumor visible on both sides of the cartilage. Tumor volume was calculated by using the summation-of-areas technique. Seven patients underwent postoperative radiation therapy. All patients had a follow-up of at least 24 months after treatment or until local recurrence. RESULTS: Eleven patients showed cartilage abnormalities. In six patients, only a single cartilage was abnormal, whereas three patients showed involvement of two cartilages and two patients of three cartilages. The overall average tumor volume was 2.7 mL; the average tumor volume was 1.5 mL in the patients without and 3.3 mL in those with cartilage involvement on CT (P > .05). Two patients suffered a local recurrence. One patient (tumor volume, 1.5 mL) did not show any cartilage abnormalities. The other patient (tumor volume, 1.9 mL) showed abnormalities in all three cartilages and also had evidence of early transcartilaginous tumor spread. CONCLUSION: In patients whose cancer is anatomically suitable for partial laryngectomy, cartilage abnormalities on CT do not preclude speech-preserving surgery.     

Imaging of small bowel Crohn's disease: can abdominal CT replace barium radiography?

Objectives: To analyze imaging features and compare the diagnostic information provided by abdominal computed tomography (CT) and enteroclysis to see whether CT can replace barium examinations in the assessment of patients with small bowel Crohn's disease. Methods: The abdominal CT studies and enteroclysis of 33 patients with small bowel Crohn's disease who underwent both examinations within a 2-week time period were retrospectively reviewed and scored for the presence and severity of the following features: mural edema, ulceration, small bowel obstruction, stricture, sinus tract formation, fistula, abscess, extraintestinal manifestations, and total number of intestinal sites involved. The statistical significance of the differences for each variable was calculated. Results: A total of 37 case sets were reviewed. CT demonstrated 10 (27 %) abscesses compared to 7 (19 %) shown by enteroclysis. Three extraintestinal sites shown by CT were not demonstrated by enteroclysis. Enteroclysis detected a larger number of intestinal sites of involvement (54 vs. 47) and more cases of ulceration (78 % vs. 19 %), small bowel obstruction (46 % vs. 16 %), stricture (38 % vs. 11 %), fistula formation (24 % vs. 8 %), and sinus tract formation (27 % vs. 5 %). The two modalities were similar in characterizing and grading the severity of mural thickening (CT showed 41 %, enteroclysis 46 %). Conclusion: Abdominal CT and enteroclysis provide unique and complementary diagnostic information in patients with Crohn's disease of the small bowel. Both methods may be required for the accurate assessment of the severity and extent of Crohn's disease of the small bowel. The choice of initial examination will depend on the clinical issue in question.     

外伤性颈动脉海绵窦瘘的综合影像评价

目的 评价各种影像学检查手段在诊断外伤性颈内动脉海绵窦瘘中的作用。资料与方法 回顾性分析15例颈动脉海绵窦瘘患者的各种影像学表现，其中CT、超声检查15例，脑血管造影12例，MRI检查3例。结果 颈内动脉海绵窦瘘CT表现为：眼球突出，眼上静脉扩张和海绵窦增大(15／15)，眶内软组织肿胀(9／15)和眼外肌肥厚(10／15)。MRI表现与CT大致相同，MRA可立体显示扩张的眼上静脉和瘘口(2／3)。脑血管造影于动脉期可见患侧海绵窦扩大显影并眼上静脉逆向充盈显影(12／12)，并可见瘘口显示(11／12)，压迫患侧颈总动脉，健侧颈内动脉造影可见患侧颈内动脉和海绵窦显影(9／12)。经颅多普勒超声检查可显示眼上静脉和海绵窦区的异常血流信号(15／15)，并能准确评价颈内动脉各段血流动力学改变。结论 各种影像学检查手段都有其优势和局限性，各种手段综合应用才能满足临床需要。     

Craniofacial mucormycosis: assessment with CT

Computed tomographic (CT) scans of ten patients with rhinocerebral mucormycosis were reviewed. Early paranasal sinus involvement appeared as mucosal thickening on CT scans, usually without air/fluid levels. Recognition as mucormycosis was facilitated by knowledge of the clinical setting or by identification of invasive disease. Evidence of bone destruction on CT scans was seen in only two patients, was a late finding, and usually was absent despite deep extension of disease beyond the bony confines of the paranasal sinus. Five cases had intracranial involvement, either as fungal abscess or infarction. Intracranial mucormycosis usually involved the base of the brain and cerebellum following invasion of the infratemporal fossa or orbit. Intracerebral fungal abscess appeared as low-density masses on CT scans, with variable peripheral enhancement and little surrounding vasogenic edema. Identification of a rim of spared cortex was useful in distinguishing infection from bland infarct. Serial CT scans were also useful in assessing response to hyperbaric oxygen treatment, surgery, and chemotherapy.     

Cervicofacial actinomycosis: CT and MR imaging findings in seven patients

BACKGROUND AND PURPOSE: Cervicofacial actinomycosis is uncommon, but without proper treatment it causes extensive tissue destruction. Early diagnosis is critical but usually difficult with cultures or imaging. Our aim was to identify characteristic imaging features that facilitated diagnosis in seven patients with cervicofacial actinomycosis. METHODS: We retrospectively reviewed the CT and MR findings in seven patients with pathologically proved actinomycosis. Histologic diagnosis was made by means of surgical excision or biopsy in seven patients. Culturing was performed in two patients. Enhanced CT scans (n=7) and MR images (n=2) were evaluated for the location, margin, infiltrative nature, enhancement pattern, and presence of lymphadenopathy. RESULTS: CT and MR images showed either a well-defined (n=2) or ill-defined (n=5) mass. Involved areas included the nasal cavity (n=2), buccal space (n=1), pyriform sinus (n=1), aryepiglottic fold (n=1), oro- and hypopharynx (n=1) and tongue (n=1). Imaging confirmed the infiltrative nature, showing the tendency of the lesion to invade across tissue planes and boundaries (n=6). Moderate homogeneous contrast enhancement was seen on CT scans in six patients with several small low-attenuating foci (n=2). T1- and T2-weighted MR images showed intermediate signal intensity with moderate contrast enhancement (n=2). Reactive lymphadenopathy was associated in three patients. CONCLUSION: Although cervicofacial actinomycosis occurs infrequently, it should be included in the differential diagnosis when images show a soft-tissue mass with inflammatory changes and an infiltrative nature in the cervicofacial area.     

Using CT to localize side and level of vocal cord paralysis

OBJECTIVE: The purpose of our study was to assess the relative accuracy of imaging findings related to peripheral recurrent nerve paralysis on axial CT studies of the neck. Also assessed were imaging findings of a central vagal neuropathy. MATERIALS AND METHODS: We retrospectively identified 40 patients who had clinically diagnosed vocal cord paralysis and had undergone CT. Eight imaging signs of vocal cord paralysis were assessed, and an imaging distinction between a central or peripheral vagal neuropathy was made by evaluating asymmetric dilatation of the oropharynx with thinning of the constrictor muscles. In two patients, we studied the use of reformatted coronal images from a multidetector CT scanner. RESULTS: For unilateral vocal cord paralysis, the most sensitive imaging findings were ipsilateral pyriform sinus dilatation, medial positioning and thickening of the ipsilateral aryepiglottic fold, and ipsilateral laryngeal ventricle dilatation. In two patients, coronal reformatted images aided the diagnosis by better showing flattening of the subglottic arch. Imaging findings allowed localization of a central vagal neuropathy in four patients. CONCLUSION: Three reliable imaging findings associated with vocal cord paralysis were identified on routine axial CT studies: ipsilateral pyriform sinus dilatation, medial positioning and thickening of the ipsilateral aryepiglottic fold, and ipsilateral laryngeal ventricle dilatation. Coronal reformatted images of the larynx may be helpful, but they are not necessary in 95% of patients. Ipsilateral pharyngeal constrictor muscle atrophy is a helpful imaging finding to localize a more central vagal neuropathy. Our findings can aid radiologists in identifying peripheral and central vagal neuropathy in patients who present for CT of the neck who have a normal voice and are without a history suggestive of a vagal problem.     

Pleural empyema secondary to nephropleural fistula in complicated pyonephrosis

Pleural empyema of extra pulmonary origin is uncommon and empyema secondary to a fistula between the urinary tract and thorax is extremely rare. We report a case of nephropleural fistula causing massive pleural empyema in a 64-year-old woman with a long history of urological problems, including nephrolitiasis and urinary tract infection. She was admitted with sepsis, fever, chills, tachypnea, productive cough and pyuria. At clinical examination, breath sounds were reduced over the left hemithorax. CT revealed a fistulous connection from the upper left calyceal group and the pleural space. Drainage of thoracic and perinephric collection was carried out, but nephrectomy and pleural decortication were required due to haemopurulent urine and decreased hemoglobin levels during the hospitalization. This case demonstrates the unusual and prolonged evolution of an obstructive hydroureteronephrosis complicated by pyonephrosis, culminating in retroperitoneal abscess that fistulized into the pleural space, leading to empyema.     

CT引导下经皮穿刺肺脓肿引流术的临床应用

目的　探讨CT引导下经皮穿刺肺脓肿引流术的临床应用。方法　对 18例肺脓肿行CT引导下经皮穿刺引流术 ,其中 8例直接用穿刺针抽吸脓液 1～ 3次 ,10例放置引流管持续引流。结果　17例手术获得成功 ,成功率 94 .4 % (17 18)。随访 11～ 35d ,症状明显好转、病灶缩小或消失 16例 ,治愈率 88.9% (16 18)。并发症 :穿刺发生气胸 4例 ,气胸量 <30 % 3例 ,>30 % 1例。结论　CT引导下经皮穿刺肺脓肿引流术 ,可缩短病程 ,创伤小 ,操作简单 ,只要掌握好适应证和技术要领 ,成功率、治愈率高 ,并发症少而轻 ,值得推广应用。