Acute Suppurative Thyroiditis and Internal Fistula Originating from the Apex of a Left Piriform Sinus

Abstract

Acute suppurative thyroiditis is rare, particularly in children. Thirty case of acute suppurative thyroiditis, to our knowledge, have been documented in the literature. In most cases the route of infection has not been obvious. We describe here a pyriform sinus fistula which may be a common route of infection in this condition and describe in detail three recurrent episodes of acute suppurative thyroiditis in a 12-year-old girl. A barium meal revealed a fistula originating from the apex of the left pyriform sinus. Fistulas seem to be a common route of infection in acute suppurative thyroiditis, allowing bacterial infection to begin in the perithyroid space and spread to the thyroid gland. Complete extirpation of the fistula is required for permanent cure.