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
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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Related Differential Diagnoses
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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
Definitions
4th branchial apparatus sinus tract
Course from apex of pyriform sinus to upper aspect of left thyroid lobe
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
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
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