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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Synonyms
- Pyriform sinus "fistula"
- Most 4th branchial anomalies are actually sinus tracts, not fistulas or cysts
- Pyriform sinus "fistula"
Definitions
- 4th branchial apparatus sinus tract
- Course from apex of pyriform sinus to upper aspect of left thyroid lobe
- Branchial sinus tract: 1 opening-to-skin surface, external auditory canal, pharynx or hypopharynx
- Branchial fistula: 2 openings; skin and lumen of foregut
- Arises from epithelial-lined tract left behind when there is persistence of both branchial cleft and its corresponding pharyngeal pouch
- 4th branchial apparatus sinus tract
IMAGING
General Features
Fluoroscopic Findings
CT Findings
MR Findings
Ultrasonographic Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
- Prosser JD et al: Branchial cleft anomalies and thymic cysts. Otolaryngol Clin North Am. 48(1):1-14, 2015
- Goff CJ et al: Current management of congenital branchial cleft cysts, sinuses, and fistulae. Curr Opin Otolaryngol Head Neck Surg. 20(6):533-9, 2012
- Bajaj Y et al: Branchial anomalies in children. Int J Pediatr Otorhinolaryngol. 75(8):1020-3, 2011
- Pahlavan S et al: Microbiology of third and fourth branchial pouch cysts. Laryngoscope. 120(3):458-62, 2010
- Thomas B et al: Revisiting imaging features and the embryologic basis of third and fourth branchial anomalies. AJNR Am J Neuroradiol. 31(4):755-60, 2010
- Nicoucar K et al: Management of congenital fourth branchial arch anomalies: a review and analysis of published cases. J Pediatr Surg. 44(7):1432-9, 2009
- Mantle BA et al: Fourth branchial cleft sinus: relationship to superior and recurrent laryngeal nerves. Am J Otolaryngol. 29(3):198-200, 2008
- James A et al: Branchial sinus of the piriform fossa: reappraisal of third and fourth branchial anomalies. Laryngoscope. 117(11):1920-4, 2007
- Garrel R et al: Fourth branchial pouch sinus: from diagnosis to treatment. Otolaryngol Head Neck Surg. 134(1):157-63, 2006
- Koch BL: Cystic malformations of the neck in children. Pediatr Radiol. 35(5):463-77, 2005
- Jeyakumar A et al: Various presentations of fourth branchial pouch anomalies. Ear Nose Throat J. 83(9):640-2, 644, 2004
- Pereira KD et al: Management of anomalies of the third and fourth branchial pouches. Int J Pediatr Otorhinolaryngol. 68(1): 43-50, 2004
- Chaudhary N et al: Fistula of the fourth branchial pouch. Am J Otolaryngol. 24(4): 250-2, 2003
- Wang HK et al: Imaging studies of pyriform sinus fistula. Pediatr Radiol. 33(5):328-33, 2003
- Liberman M et al: Ten years of experience with third and fourth branchial remnants. J Pediatr Surg. 37(5): 685-90, 2002
- Link TD et al: Fourth branchial pouch sinus: a diagnostic challenge. Plast Reconstr Surg. 108(3): 695-701, 2001
- Minhas SS et al: Fourth branchial arch fistula and suppurative thyroiditis: a life-threatening infection. J Laryngol Otol. 115(12): 1029-31, 2001
- Mandell DL: Head and neck anomalies related to the branchial apparatus. Otolaryngol Clin North Am. 33(6): 1309-32, 2000
- Nicollas R et al: Congenital cysts and fistulas of the neck. Int J Pediatr Otorhinolaryngol. 55(2): 117-24, 2000
- Park SW et al: Neck infection associated with pyriform sinus fistula: imaging findings. AJNR Am J Neuroradiol. 21(5):817-22, 2000
- Stone ME et al: A new role for computed tomography in the diagnosis and treatment of pyriform sinus fistula. Am J Otolaryngol. 21(5):323-5, 2000
- Yang C et al: Fourth branchial arch sinus: clinical presentation, diagnostic workup, and surgical treatment. Laryngoscope. 109(3): 442-6, 1999
- Nicollas R et al: Fourth branchial pouch anomalies: a study of six cases and review of the literature. Int J Pediatr Otorhinolaryngol. 44(1): 5-10, 1998
- Cote DN et al: Fourth branchial cleft cysts. Otolaryngol Head Neck Surg. 114(1): 95-7, 1996
- Choi SS et al: Branchial anomalies: a review of 52 cases. Laryngoscope. 105(9 Pt 1): 909-13, 1995
- Benson MT et al: Congenital anomalies of the branchial apparatus: embryology and pathologic anatomy. Radiographics. 12(5):943-60, 1992
- Rosenfeld RM et al: Fourth branchial pouch sinus: diagnosis and treatment. Otolaryngol Head Neck Surg. 105(1): 44-50, 1991
- Godin MS et al: Fourth branchial pouch sinus: principles of diagnosis and management. Laryngoscope. 100(2 Pt 1): 174-8, 1990
- Lucaya J et al: Congenital pyriform sinus fistula: a cause of acute left-sided suppurative thyroiditis and neck abscess in children. Pediatr Radiol. 21(1):27-9, 1990
- Taylor WE Jr et al: Acute suppurative thyroiditis in children. Laryngoscope. 92(11):1269-73, 1982
Related Anatomy
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Synonyms
- Pyriform sinus "fistula"
- Most 4th branchial anomalies are actually sinus tracts, not fistulas or cysts
- Pyriform sinus "fistula"
Definitions
- 4th branchial apparatus sinus tract
- Course from apex of pyriform sinus to upper aspect of left thyroid lobe
- Branchial sinus tract: 1 opening-to-skin surface, external auditory canal, pharynx or hypopharynx
- Branchial fistula: 2 openings; skin and lumen of foregut
- Arises from epithelial-lined tract left behind when there is persistence of both branchial cleft and its corresponding pharyngeal pouch
- 4th branchial apparatus sinus tract
IMAGING
General Features
Fluoroscopic Findings
CT Findings
MR Findings
Ultrasonographic Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
- Prosser JD et al: Branchial cleft anomalies and thymic cysts. Otolaryngol Clin North Am. 48(1):1-14, 2015
- Goff CJ et al: Current management of congenital branchial cleft cysts, sinuses, and fistulae. Curr Opin Otolaryngol Head Neck Surg. 20(6):533-9, 2012
- Bajaj Y et al: Branchial anomalies in children. Int J Pediatr Otorhinolaryngol. 75(8):1020-3, 2011
- Pahlavan S et al: Microbiology of third and fourth branchial pouch cysts. Laryngoscope. 120(3):458-62, 2010
- Thomas B et al: Revisiting imaging features and the embryologic basis of third and fourth branchial anomalies. AJNR Am J Neuroradiol. 31(4):755-60, 2010
- Nicoucar K et al: Management of congenital fourth branchial arch anomalies: a review and analysis of published cases. J Pediatr Surg. 44(7):1432-9, 2009
- Mantle BA et al: Fourth branchial cleft sinus: relationship to superior and recurrent laryngeal nerves. Am J Otolaryngol. 29(3):198-200, 2008
- James A et al: Branchial sinus of the piriform fossa: reappraisal of third and fourth branchial anomalies. Laryngoscope. 117(11):1920-4, 2007
- Garrel R et al: Fourth branchial pouch sinus: from diagnosis to treatment. Otolaryngol Head Neck Surg. 134(1):157-63, 2006
- Koch BL: Cystic malformations of the neck in children. Pediatr Radiol. 35(5):463-77, 2005
- Jeyakumar A et al: Various presentations of fourth branchial pouch anomalies. Ear Nose Throat J. 83(9):640-2, 644, 2004
- Pereira KD et al: Management of anomalies of the third and fourth branchial pouches. Int J Pediatr Otorhinolaryngol. 68(1): 43-50, 2004
- Chaudhary N et al: Fistula of the fourth branchial pouch. Am J Otolaryngol. 24(4): 250-2, 2003
- Wang HK et al: Imaging studies of pyriform sinus fistula. Pediatr Radiol. 33(5):328-33, 2003
- Liberman M et al: Ten years of experience with third and fourth branchial remnants. J Pediatr Surg. 37(5): 685-90, 2002
- Link TD et al: Fourth branchial pouch sinus: a diagnostic challenge. Plast Reconstr Surg. 108(3): 695-701, 2001
- Minhas SS et al: Fourth branchial arch fistula and suppurative thyroiditis: a life-threatening infection. J Laryngol Otol. 115(12): 1029-31, 2001
- Mandell DL: Head and neck anomalies related to the branchial apparatus. Otolaryngol Clin North Am. 33(6): 1309-32, 2000
- Nicollas R et al: Congenital cysts and fistulas of the neck. Int J Pediatr Otorhinolaryngol. 55(2): 117-24, 2000
- Park SW et al: Neck infection associated with pyriform sinus fistula: imaging findings. AJNR Am J Neuroradiol. 21(5):817-22, 2000
- Stone ME et al: A new role for computed tomography in the diagnosis and treatment of pyriform sinus fistula. Am J Otolaryngol. 21(5):323-5, 2000
- Yang C et al: Fourth branchial arch sinus: clinical presentation, diagnostic workup, and surgical treatment. Laryngoscope. 109(3): 442-6, 1999
- Nicollas R et al: Fourth branchial pouch anomalies: a study of six cases and review of the literature. Int J Pediatr Otorhinolaryngol. 44(1): 5-10, 1998
- Cote DN et al: Fourth branchial cleft cysts. Otolaryngol Head Neck Surg. 114(1): 95-7, 1996
- Choi SS et al: Branchial anomalies: a review of 52 cases. Laryngoscope. 105(9 Pt 1): 909-13, 1995
- Benson MT et al: Congenital anomalies of the branchial apparatus: embryology and pathologic anatomy. Radiographics. 12(5):943-60, 1992
- Rosenfeld RM et al: Fourth branchial pouch sinus: diagnosis and treatment. Otolaryngol Head Neck Surg. 105(1): 44-50, 1991
- Godin MS et al: Fourth branchial pouch sinus: principles of diagnosis and management. Laryngoscope. 100(2 Pt 1): 174-8, 1990
- Lucaya J et al: Congenital pyriform sinus fistula: a cause of acute left-sided suppurative thyroiditis and neck abscess in children. Pediatr Radiol. 21(1):27-9, 1990
- Taylor WE Jr et al: Acute suppurative thyroiditis in children. Laryngoscope. 92(11):1269-73, 1982
