1992 Volume 85 Issue 1 Pages 55-59
Although persistence of the bursa pharyngea is observed in 4% of human adults, it is usually asymptomatic without inflammation. To date, there have been 10 reports of Tornwaldt's disease in Japan. In some of these reports, the authors confused the name of disease, so the actual number of cases of true Tornwaldt's disease is smaller. Our patient with Tornwaldt's disease is reported because of the rarity of the condition. A 41-year-old man complained of occipital and temporal headache with symptoms similar to cervical vertigo. Horizontal nystagmus was seen in suspending and rotaing head positions. A 1.5cm diameter round mass covered with slightly injected mucosa was present in the midline of the posterior nasopharyngeal wall. MRI revealed a well-defined oval cyst between the nasopharyngeal mucosa and the vertebrae. In the coronal image, the cyst was located in the midline between the longus capitis muscles, and in the sagittal image, the cyst had a tear-drop shape. The cystic mass was removed by a trans-palatal approach using a contact Nd-YAG laser. Histological examination revealed a cyst lined with ciliated columnar epithelium and the presence of numerous inflammatory cells. The patient was relieved of his symptoms 1 week after surgery. We considered that the cervical vertigo-like symptoms were caused by irritation of the sympathetic plexus surrounding the basilar artery induced by inflammation of the cyst, and that MR imaging was very useful in the diagnosis of Tornwaldt's disease.