Chatchomchaun Waralee, Thewjitcharoen Yotsapon, Krittadhee Karndumri, Veerasomboonsin Veekij, Nakasatien Soontaree, Krittiyawong Sirinate, Porramatikul Sriurai, Wanathayanoroj Ekgaluck, Kanchanapituk Auchai, Junyangdikul Pairoj, Himathongkam Thep
Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand.
Department of Pathology, Samitivej Srinakarin Hospital, Bangkok Hospital Group, Bangkok, Thailand.
Endocrinol Diabetes Metab Case Rep. 2020 Jun 4;2020. doi: 10.1530/EDM-20-0047.
In this case report, we describe a 37-year-old male who presented with fever and tender neck mass. Neck ultrasonography revealed a mixed echogenic multiloculated solid-cystic lesion containing turbid fluid and occupying the right thyroid region. Thyroid function tests showed subclinical hyperthyroidism. The patient was initially diagnosed with thyroid abscess and he was subsequently treated with percutaneous aspiration and i.v. antibiotics; however, his clinical symptoms did not improve. Surgical treatment was then performed and a pathological examination revealed a ruptured epidermoid cyst with abscess formation. No thyroid tissue was identified in the specimen. The patient was discharged uneventfully. However, at the 3-month and 1-year follow-ups, the patient was discovered to have developed subclinical hypothyroidism. Neck ultrasonography revealed a normal thyroid gland. This report demonstrates a rare case of epidermoid cyst abscess in the cervical region, of which initial imaging and abnormal thyroid function tests led to the erroneous diagnosis of thyroid abscess.
Epidermoid cyst abscess at the cervical region can mimic thyroid abscess. Neck ultrasonography cannot distinguish thyroid abscess from epidermoid cyst abscess. Thyroid function may be altered due to the adjacent soft tissue inflammation.
在本病例报告中，我们描述了一名37岁男性，其表现为发热和颈部压痛性肿块。颈部超声检查发现一个混合回声的多房性实性囊性病变，内含浑浊液体，占据右侧甲状腺区域。甲状腺功能检查显示亚临床甲状腺功能亢进。患者最初被诊断为甲状腺脓肿，随后接受了经皮穿刺抽吸和静脉注射抗生素治疗；然而，其临床症状并未改善。随后进行了手术治疗，病理检查显示为破裂的表皮样囊肿并伴有脓肿形成。标本中未发现甲状腺组织。患者顺利出院。然而，在3个月和1年的随访中，发现该患者出现了亚临床甲状腺功能减退。颈部超声检查显示甲状腺正常。本报告展示了一例罕见的颈部表皮样囊肿脓肿病例，其最初的影像学检查和异常的甲状腺功能检查导致了甲状腺脓肿的误诊。
颈部表皮样囊肿脓肿可酷似甲状腺脓肿。颈部超声检查无法区分甲状腺脓肿和表皮样囊肿脓肿。甲状腺功能可能因邻近软组织炎症而改变。
