PMC3420472_01
Fluoroscopic sinogram of pigtail catheter drain in the right lateral neck. (a) Anteroposterior view depicting pigtail catheter placed in the right cervical abscess. (b) Oblique view shows contrast exiting catheter and flowing into a fistulous tract leading to (c) the apex of the right pyriform sinus. (d) Lateral view.
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fig1
During her hospital stay the patient underwent a fluoroscopic sinogram of the pigtail catheter drain and her cystic neck mass to further explore its origin (Figure 1).
Fistulous tract (arrow) visualized in the right pyriform sinus adjacent to esophagus (arrowhead).
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fig2
Two weeks later she was taken to the operating room for direct laryngoscopy, esophagoscopy (Figures 2 and 3), and chemocauterization of the fistulous tract with 40% trichloroacetic acid (TCA).
Right pyriform sinus fistulous tract cannulated with straight laryngeal probe (arrow).
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fig3
Two weeks later she was taken to the operating room for direct laryngoscopy, esophagoscopy (Figures 2 and 3), and chemocauterization of the fistulous tract with 40% trichloroacetic acid (TCA).
Laryngeal forceps used to insert TCA-soaked micropledget into fistulous tract.
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fig4
TCA were carefully placed into the fistulous tract (Figure 4). This was repeated for a total of three times, and the area was then rinsed with saline and inspected (Figure 5).
Ablated fistulous tract after cauterization with 40% TCA.
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fig5
TCA were carefully placed into the fistulous tract (Figure 4). This was repeated for a total of three times, and the area was then rinsed with saline and inspected (Figure 5).
Esophagram (anteroposterior and lateral views) of cervical esophagus with barium swallow demonstrating a slight widemouthed outpouching of the right hypopharynx without contrast pooling. There is absence of a fistulous tract.
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fig6
Repeat esophagram four months later confirmed fistula closure (Figure 6).