EURORAD ESR

Case 8884

Thyroglossal duct fistula

Author(s)
Kotoula A, Boutsiadis K, Barmpalios G, Psoma E, Ntomouchtsis A, Kechagias N, Christoforidou V.
 
Patient
male, 48 year(s)
 
 
  • Figure 1
    Fistulography
     

    Lateral view depicts the thyroglossal tract (arrow), and a sinus dilatation in a suprahyoid position (empty arrowheads). Note the extension of the tract to the base of the tongue (empty arrow). [C:cannula, H:hyoid bone]

     

    New side branch appears in a later view starting from the level of the foramen ceacum (empty black arrow) and leading to a sinus dilatation superior to the hyoid bone (empty arrowheads) [H:hyoid bone, arrow:main tract]

     

    Anterioposterior view demonstrates the midline position of the thyroglossal tract [C:cannula].

     

    Cannulation of the cutaneous opening.

     
     
     
  • Figure 2
    Ultrasound
     

    Ultrasound examination just above the thyroid isthmus shows an ovoid hypoechoic lesion, surrounded by hyperechoic tissue (open arrow). No clear posterior enhancement was noted.

     

    Doppler US revealed a subtle flow in the periphery of the lesion (open arrow).

     
     
     
  • Figure 3
    Contrast enhanced CT
     

    CECT at the upper level of the thyroid gland shows ring enhancement of the main duct and obliteration of the surrounding fat due to the prior surgery or previous infections (arrow).

     

    CECT at the level of the calcified thyroid cartilage also presents the mild enhancement of the main duct and the adjacent fat stranding (arrow).

     

    CECT cranially to the hyoid bone depicts the multiple cystic components of the sinus with peripheral enhancement.

     
     
     
  • Figure 4
    MRI
     

    Sagittal T1-weighted image shows low signal of the thyroglossal sinus and cysts above the hyoid bone (arrow).

     

    Sagittal fat-suppressed T2 weighted image demonstrates the suprahyoid thyroglosal sinuses and cysts with high signal intensity (arrow) and the projection of the tract to the base of the tongue.

     

    Coronal STIR image demonstates the high signal intensity of a cystic suprahyoid lesion (open arrow).

     

    Axial post gadolinium T1-weighted image shows the ring enhancement of the cysts (empty arrowhead). Note the cluster of cysts just in front of the hypopharynx (arrowhead).

     
     
     
  • Figure 5
    99m Tc Scintigram

    No ectopic thyroid tissue was demonstrated in the scintigram.

     
     
     
  • Figure 6
    The Sistrunk surgical procedure
     

    A fistulous ostium is noted in infrahyoid position just left from the midline.

     

    An elliptic excision is indicated in the presence of a fistula, previous infection or drainage procedure.

     

    The surgeon removes the middle third of the hyoid with bone-cutting forceps.

     

    The thyroglossal tract has been skeletonized, and the assistant is retracting the specimen.

     
     
     
  • Figure 7
    Gross and cut specimens
     

    Surgical gross specimen (scale in centimetres and inches).

     

    Cut specimen showing the main thyroglossal duct and the cut middle portion of the hyoid bone.

     

    Cut specimen of the suprahyoid region demonstates the cluster of cystic lesions.

     

    Cut specimen of the suprahyoid region demonstates the cluster of cystic lesions.

     
     
     
  • Figure 8
    Photomicrograph (HE stain)
     

    Sinus tracts lined by pseudostatified ciliated epithelium (arrow). Thyroid follicles are seen in the subjacent stroma (arrowheads) [HE x200].

     

    Sinus tract lined by pseudostratified ciliated epithelium. Secondary inflammation cells are seen in the subjacent stroma [HE x400].

     
     
     
Lateral view depicts the thyroglossal tract (arrow), and a sinus dilatation in a suprahyoid position (empty arrowheads). Note the extension of the tract to the base of the tongue (empty arrow). [C:cannula, H:hyoid bone]
 
New side branch appears in a later view starting from the level of the foramen ceacum (empty black arrow) and leading to a sinus dilatation superior to the hyoid bone (empty arrowheads) [H:hyoid bone, arrow:main tract]
 
Anterioposterior view demonstrates the midline position of the thyroglossal tract [C:cannula].
 
Cannulation of the cutaneous opening.
 
Ultrasound examination just above the thyroid isthmus shows an ovoid hypoechoic lesion, surrounded by hyperechoic tissue (open arrow). No clear posterior enhancement was noted.
 
Doppler US revealed a subtle flow in the periphery of the lesion (open arrow).
 
CECT at the upper level of the thyroid gland shows ring enhancement of the main duct and obliteration of the surrounding fat due to the prior surgery or previous infections (arrow).
 
CECT at the level of the calcified thyroid cartilage also presents the mild enhancement of the main duct and the adjacent fat stranding (arrow).
 
CECT cranially to the hyoid bone depicts the multiple cystic components of the sinus with peripheral enhancement.
 
Sagittal T1-weighted image shows low signal of the thyroglossal sinus and cysts above the hyoid bone (arrow).
 
Sagittal fat-suppressed T2 weighted image demonstrates the suprahyoid thyroglosal sinuses and cysts with high signal intensity (arrow) and the projection of the tract to the base of the tongue.
 
Coronal STIR image demonstates the high signal intensity of a cystic suprahyoid lesion (open arrow).
 
Axial post gadolinium T1-weighted image shows the ring enhancement of the cysts (empty arrowhead). Note the cluster of cysts just in front of the hypopharynx (arrowhead).
 
No ectopic thyroid tissue was demonstrated in the scintigram.
 
A fistulous ostium is noted in infrahyoid position just left from the midline.
 
An elliptic excision is indicated in the presence of a fistula, previous infection or drainage procedure.
 
The surgeon removes the middle third of the hyoid with bone-cutting forceps.
 
The thyroglossal tract has been skeletonized, and the assistant is retracting the specimen.
 
Surgical gross specimen (scale in centimetres and inches).
 
Cut specimen showing the main thyroglossal duct and the cut middle portion of the hyoid bone.
 
Cut specimen of the suprahyoid region demonstates the cluster of cystic lesions.
 
Cut specimen of the suprahyoid region demonstates the cluster of cystic lesions.
 
Sinus tracts lined by pseudostatified ciliated epithelium (arrow). Thyroid follicles are seen in the subjacent stroma (arrowheads) [HE x200].
 
Sinus tract lined by pseudostratified ciliated epithelium. Secondary inflammation cells are seen in the subjacent stroma [HE x400].
 
 
 
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