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Acute Suppurative Thyroiditis
Eunice Y. L. Dai, MBBS, FRCR; Yolanda Y. P. Lee, MBChB, FRCR; Anil T. Ahuja, MD, FRCR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Acute suppurative thyroiditis (AST)
            • Synonyms

              • Acute pyogenic thyroiditis
            • Definitions

              • Acute bacterial infection of thyroid gland

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • Fluoroscopic Findings

                  • CT Findings

                    • MR Findings

                      • Nuclear Medicine Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Zhang P et al: Recurrent neck lesions secondary to pyriform sinus fistula. Eur Arch Otorhinolaryngol. 273(3):735-9, 2016
                                              2. Hong HS et al: Ultrasonography of various thyroid diseases in children and adolescents: a pictorial essay. Korean J Radiol. 16(2):419-29, 2015
                                              3. Mou JW et al: Recurrent deep neck abscess and piriform sinus tract: a 15-year review on the diagnosis and management. J Pediatr Surg. 49(8):1264-7, 2014
                                              4. Cha W et al: Chemocauterization of the internal opening with trichloroacetic acid as first-line treatment for pyriform sinus fistula. Head Neck. 35(3):431-5, 2013
                                              5. Wong KT et al: Benign thyroid conditions. In Sofferman et al: Ultrasound of the Thyroid and Parathyroid Glands. New York: Springer. 61-106, 2012
                                              6. Masuoka H et al: Imaging studies in sixty patients with acute suppurative thyroiditis. Thyroid. 21(10):1075-80, 2011
                                              7. Koch B: 4th branchial cleft cyst. In Harnsberger R et al: Diagnostic Imaging: Head and Neck. 2nd ed. Salt Lake City: Amirsys, Inc. III-1-36-39, 2010
                                              8. Paes JE et al: Acute bacterial suppurative thyroiditis: a clinical review and expert opinion. Thyroid. 20(3):247-55, 2010
                                              9. Pahlavan S et al: Microbiology of third and fourth branchial pouch cysts. Laryngoscope. 120(3):458-62, 2010
                                              10. 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
                                              11. 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
                                              12. Mantle BA et al: Fourth branchial cleft sinus: relationship to superior and recurrent laryngeal nerves. Am J Otolaryngol. 29(3):198-200, 2008
                                              13. Gopan T et al: Recurrent acute suppurative thyroiditis attributable to a piriform sinus fistula in an adult. Endocr Pract. 13(6):662-6, 2007
                                              14. James A et al: Branchial sinus of the piriform fossa: reappraisal of third and fourth branchial anomalies. Laryngoscope. 117(11):1920-4, 2007
                                              15. Garrel R et al: Fourth branchial pouch sinus: from diagnosis to treatment. Otolaryngol Head Neck Surg. 134(1):157-63, 2006
                                              16. Koch BL: Cystic malformations of the neck in children. Pediatr Radiol. 35(5):463-77, 2005
                                              17. Miyauchi A et al: Computed tomography scan under a trumpet maneuver to demonstrate piriform sinus fistulae in patients with acute suppurative thyroiditis. Thyroid. 15(12):1409-13, 2005
                                              18. Jeyakumar A et al: Various presentations of fourth branchial pouch anomalies. Ear Nose Throat J. 83(9):640-2, 644, 2004
                                              19. Pereira KD et al: Management of anomalies of the third and fourth branchial pouches. Int J Pediatr Otorhinolaryngol. 68(1): 43-50, 2004
                                              20. Chaudhary N et al: Fistula of the fourth branchial pouch. Am J Otolaryngol. 24(4): 250-2, 2003
                                              21. Wang HK et al: Imaging studies of pyriform sinus fistula. Pediatr Radiol. 33(5):328-33, 2003
                                              22. Liberman M et al: Ten years of experience with third and fourth branchial remnants. J Pediatr Surg. 37(5): 685-90, 2002
                                              23. Link TD et al: Fourth branchial pouch sinus: a diagnostic challenge. Plast Reconstr Surg. 108(3): 695-701, 2001
                                              24. Minhas SS et al: Fourth branchial arch fistula and suppurative thyroiditis: a life-threatening infection. J Laryngol Otol. 115(12): 1029-31, 2001
                                              25. Cases JA et al: Recurrent acute suppurative thyroiditis in an adult due to a fourth branchial pouch fistula. J Clin Endocrinol Metab. 85(3): 953-6, 2000
                                              26. Mandell DL: Head and neck anomalies related to the branchial apparatus. Otolaryngol Clin North Am. 33(6): 1309-32, 2000
                                              27. Nicollas R et al: Congenital cysts and fistulas of the neck. Int J Pediatr Otorhinolaryngol. 55(2): 117-24, 2000
                                              28. Park SW et al: Neck infection associated with pyriform sinus fistula: imaging findings. AJNR Am J Neuroradiol. 21(5):817-22, 2000
                                              29. 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
                                              30. Yang C et al: Fourth branchial arch sinus: clinical presentation, diagnostic workup, and surgical treatment. Laryngoscope. 109(3): 442-6, 1999
                                              31. Ahuja AT et al: The role of ultrasound and oesophagography in the management of acute suppurative thyroiditis in children associated with congenital pyriform fossa sinus. Clin Radiol. 53(3):209-11, 1998
                                              32. 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
                                              33. Cote DN et al: Fourth branchial cleft cysts. Otolaryngol Head Neck Surg. 114(1): 95-7, 1996
                                              34. Choi SS et al: Branchial anomalies: a review of 52 cases. Laryngoscope. 105(9 Pt 1): 909-13, 1995
                                              35. Benson MT et al: Congenital anomalies of the branchial apparatus: embryology and pathologic anatomy. Radiographics. 12(5):943-60, 1992
                                              36. Rosenfeld RM et al: Fourth branchial pouch sinus: diagnosis and treatment. Otolaryngol Head Neck Surg. 105(1): 44-50, 1991
                                              37. Godin MS et al: Fourth branchial pouch sinus: principles of diagnosis and management. Laryngoscope. 100(2 Pt 1): 174-8, 1990
                                              38. 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
                                              39. 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

                                                        • Abbreviations

                                                          • Acute suppurative thyroiditis (AST)
                                                        • Synonyms

                                                          • Acute pyogenic thyroiditis
                                                        • Definitions

                                                          • Acute bacterial infection of thyroid gland

                                                        IMAGING

                                                        • General Features

                                                          • Ultrasonographic Findings

                                                            • Fluoroscopic Findings

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Nuclear Medicine Findings

                                                                    • Imaging Recommendations

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Zhang P et al: Recurrent neck lesions secondary to pyriform sinus fistula. Eur Arch Otorhinolaryngol. 273(3):735-9, 2016
                                                                                          2. Hong HS et al: Ultrasonography of various thyroid diseases in children and adolescents: a pictorial essay. Korean J Radiol. 16(2):419-29, 2015
                                                                                          3. Mou JW et al: Recurrent deep neck abscess and piriform sinus tract: a 15-year review on the diagnosis and management. J Pediatr Surg. 49(8):1264-7, 2014
                                                                                          4. Cha W et al: Chemocauterization of the internal opening with trichloroacetic acid as first-line treatment for pyriform sinus fistula. Head Neck. 35(3):431-5, 2013
                                                                                          5. Wong KT et al: Benign thyroid conditions. In Sofferman et al: Ultrasound of the Thyroid and Parathyroid Glands. New York: Springer. 61-106, 2012
                                                                                          6. Masuoka H et al: Imaging studies in sixty patients with acute suppurative thyroiditis. Thyroid. 21(10):1075-80, 2011
                                                                                          7. Koch B: 4th branchial cleft cyst. In Harnsberger R et al: Diagnostic Imaging: Head and Neck. 2nd ed. Salt Lake City: Amirsys, Inc. III-1-36-39, 2010
                                                                                          8. Paes JE et al: Acute bacterial suppurative thyroiditis: a clinical review and expert opinion. Thyroid. 20(3):247-55, 2010
                                                                                          9. Pahlavan S et al: Microbiology of third and fourth branchial pouch cysts. Laryngoscope. 120(3):458-62, 2010
                                                                                          10. 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
                                                                                          11. 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
                                                                                          12. Mantle BA et al: Fourth branchial cleft sinus: relationship to superior and recurrent laryngeal nerves. Am J Otolaryngol. 29(3):198-200, 2008
                                                                                          13. Gopan T et al: Recurrent acute suppurative thyroiditis attributable to a piriform sinus fistula in an adult. Endocr Pract. 13(6):662-6, 2007
                                                                                          14. James A et al: Branchial sinus of the piriform fossa: reappraisal of third and fourth branchial anomalies. Laryngoscope. 117(11):1920-4, 2007
                                                                                          15. Garrel R et al: Fourth branchial pouch sinus: from diagnosis to treatment. Otolaryngol Head Neck Surg. 134(1):157-63, 2006
                                                                                          16. Koch BL: Cystic malformations of the neck in children. Pediatr Radiol. 35(5):463-77, 2005
                                                                                          17. Miyauchi A et al: Computed tomography scan under a trumpet maneuver to demonstrate piriform sinus fistulae in patients with acute suppurative thyroiditis. Thyroid. 15(12):1409-13, 2005
                                                                                          18. Jeyakumar A et al: Various presentations of fourth branchial pouch anomalies. Ear Nose Throat J. 83(9):640-2, 644, 2004
                                                                                          19. Pereira KD et al: Management of anomalies of the third and fourth branchial pouches. Int J Pediatr Otorhinolaryngol. 68(1): 43-50, 2004
                                                                                          20. Chaudhary N et al: Fistula of the fourth branchial pouch. Am J Otolaryngol. 24(4): 250-2, 2003
                                                                                          21. Wang HK et al: Imaging studies of pyriform sinus fistula. Pediatr Radiol. 33(5):328-33, 2003
                                                                                          22. Liberman M et al: Ten years of experience with third and fourth branchial remnants. J Pediatr Surg. 37(5): 685-90, 2002
                                                                                          23. Link TD et al: Fourth branchial pouch sinus: a diagnostic challenge. Plast Reconstr Surg. 108(3): 695-701, 2001
                                                                                          24. Minhas SS et al: Fourth branchial arch fistula and suppurative thyroiditis: a life-threatening infection. J Laryngol Otol. 115(12): 1029-31, 2001
                                                                                          25. Cases JA et al: Recurrent acute suppurative thyroiditis in an adult due to a fourth branchial pouch fistula. J Clin Endocrinol Metab. 85(3): 953-6, 2000
                                                                                          26. Mandell DL: Head and neck anomalies related to the branchial apparatus. Otolaryngol Clin North Am. 33(6): 1309-32, 2000
                                                                                          27. Nicollas R et al: Congenital cysts and fistulas of the neck. Int J Pediatr Otorhinolaryngol. 55(2): 117-24, 2000
                                                                                          28. Park SW et al: Neck infection associated with pyriform sinus fistula: imaging findings. AJNR Am J Neuroradiol. 21(5):817-22, 2000
                                                                                          29. 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
                                                                                          30. Yang C et al: Fourth branchial arch sinus: clinical presentation, diagnostic workup, and surgical treatment. Laryngoscope. 109(3): 442-6, 1999
                                                                                          31. Ahuja AT et al: The role of ultrasound and oesophagography in the management of acute suppurative thyroiditis in children associated with congenital pyriform fossa sinus. Clin Radiol. 53(3):209-11, 1998
                                                                                          32. 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
                                                                                          33. Cote DN et al: Fourth branchial cleft cysts. Otolaryngol Head Neck Surg. 114(1): 95-7, 1996
                                                                                          34. Choi SS et al: Branchial anomalies: a review of 52 cases. Laryngoscope. 105(9 Pt 1): 909-13, 1995
                                                                                          35. Benson MT et al: Congenital anomalies of the branchial apparatus: embryology and pathologic anatomy. Radiographics. 12(5):943-60, 1992
                                                                                          36. Rosenfeld RM et al: Fourth branchial pouch sinus: diagnosis and treatment. Otolaryngol Head Neck Surg. 105(1): 44-50, 1991
                                                                                          37. Godin MS et al: Fourth branchial pouch sinus: principles of diagnosis and management. Laryngoscope. 100(2 Pt 1): 174-8, 1990
                                                                                          38. 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
                                                                                          39. Taylor WE Jr et al: Acute suppurative thyroiditis in children. Laryngoscope. 92(11):1269-73, 1982