2002 Volume 38 Issue 7 Pages 1080-1085
Seven days after birth, a male patient presented a left lateral cervical mass with upper airway obstruction. Plain X-ray film and CT of the neck revealed a mass with an air-fluid level on the left side of the neck. A barium esophagogram did not show a minute communication between the left piriform sinus and the cyst. The cyst was punctured and antibiotics were administered. After withdrawal of local inflammation, piriform sinus cysts and fistulous communication were excised. The lower end of the cyst was adjacent to the left lobe of the thyroid gland. The fistula penetrated the inferior pharyngeal constrictor muscle to the piriform sinus at the level of the inferior horn of the thyroid cartilage. Histopathologic examination showed that the cyst wall was composed of damaged epithelium containing parathyroid tissue. Piriform sinus fistula accompanied by cervical cyst is rare in neonates. Enlargement of the cyst in neonates may cause significant obstruction of the trachea and esophagus, which necessitates prompt aspiration or drainage. Only 28 neonatal cases have been reported in literature. Patients were predominantly male (18 of 26), and tumors were almost exclusively on the left side (26 of 28). Respiratory symptoms are recognized more frequently in neonates and infants than in older pediatric subjects.
