PMC5066581_01
A 3-year-old patient. Fistulous orifice and erythematous halo located in the anterior border of the left sternocleidomastoid muscle.
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MRI reveals the presence of pyriform sinus fistula and the extension of abscess toward pyriform fossa.
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After 8 months, an MRI revealed an expansive lesion of 2.5 cm (Figure 2) located medially to the left sternocleidomastoid muscle, with offshoots to the left antero-lateral wall of the hypopharynx.
Pyriform sinus fistula demonstrated by contrast swallow study.
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Further clinical controls revealed the reappearance of the fistulous orifice and leakage of liquid food material and saliva during swallowing as confirmed by barium swallow test (Figure 3).
(a) Endoscopical identification of the internal orifice of the fistula (little arrow) and the entrance of the esophagus (blue arrow) (b) Insertion of the probe into the fistula.
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After endoscopical identification of the internal orifice (Figure 4(a)), the fistula was catheterized (Figure 4(b)) and injected with 1 mL of Glubran 2 (Gem s.r.l.
Barium swallow test after endoscopic chemo-cauterization demonstrates the absence of leakage.
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At discharge, fistulous drainage had ceased and radiologic examination showed the absence of leakage (Figure 5).
Disappearance of fistulous orifice and detail of cutaneous scar after 6 years of follow-up.
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The clinical and radiological 6-year follow-up confirmed the absence of the fistulous orifice and the persistence of scar due to previous open-neck surgical procedures (Figure 6).