Di Nora Alessandra, Maniaci Antonino, Pizzo Francesco, Van Der Poel Nicolien, Smilari Pierluigi, Cocuzza Salvatore, Spadaro Gloria, Lentini Mario, Calvo-Henriquez Christian, Lechien Jerome R, Campisi Paolo, Parisi Federica Maria, Sangiorgio Giuseppe, Pavone Piero
Department of Clinical and Experimental Medicine, University of Catania, Catania, CT, Italy.
Department of Medicine and Surgery, University of Enna "Kore", 94100, Enna, Italy; Pediatric Study Group, Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France; Department of Otolaryngology, ASP 7, Ragusa Hospital, Ragusa, 97100, Italy.
Int J Pediatr Otorhinolaryngol. 2025 Jan;188:112212. doi: 10.1016/j.ijporl.2024.112212. Epub 2024 Dec 23.
Acute suppurative thyroiditis (AST), a rare yet potentially life-threatening infection, comprises less than 1 % of neck pathologies and requires prompt treatment. Symptoms range from neck pain and fever to dysphagia and possible abscess formation. Broad-spectrum antibiotics are the primary treatment; however, surgical drainage may be necessary for abscesses to prevent systemic infection. Following acute management, identifying underlying anomalies such as branchial arch defects that predispose to recurrence is crucial. Diagnostic tools like barium swallow or transnasal fiberoptic laryngoscopy aid in this identification process. Recurrent AST or left-sided neck abscesses often prompt investigation for fourth branchial arch anomalies like pyriform sinus fistula, which may require surgical correction to prevent future infections. This paper presents the case of a 5-year-old with left torticollis, odynophagia, and fever, previously treated for a deep neck abscess with antibiotics. Ultrasound and CT scans revealed a left thyroid lobe abscess, confirmed by barium swallow to be associated with a pyriform sinus fistula. Supported by a literature review, this case highlights the importance of a systematic approach to AST management to guide clinicians in effectively treating this uncommon condition.
急性化脓性甲状腺炎（AST）是一种罕见但可能危及生命的感染性疾病，在颈部疾病中占比不到1%，需要及时治疗。症状包括颈部疼痛、发热、吞咽困难以及可能形成脓肿。广谱抗生素是主要治疗手段；然而，对于脓肿可能需要进行外科引流以防止全身感染。在急性处理之后，识别诸如鳃弓缺陷等易导致复发的潜在异常情况至关重要。诸如吞钡检查或经鼻纤维喉镜检查等诊断工具有助于这一识别过程。复发性AST或左侧颈部脓肿常常促使对诸如梨状窦瘘等第四鳃弓异常情况进行检查，这可能需要手术矫正以预防未来感染。本文介绍了一名5岁儿童的病例，该患儿有左侧斜颈、吞咽疼痛和发热症状，此前曾使用抗生素治疗深部颈部脓肿。超声和CT扫描显示左侧甲状腺叶脓肿，吞钡检查证实与梨状窦瘘有关。通过文献综述支持，该病例凸显了采用系统方法管理AST对于指导临床医生有效治疗这种罕见疾病的重要性。
