Best of five
- A. Thyroglossal duct cyst
- B. Second branchial cyst
- C. Cystic hygroma
- D. Third or fourth branchial pouch sinus, most commonly a fourth-pouch anomaly
- E. Dermoid cyst
FRCS (ORL-HNS) · SECTION 1 SBA
Fourth branchial pouch anomaly
A child has recurrent left-sided suppurative thyroiditis and deep-neck abscesses. Endoscopy reveals an internal opening at the apex of the left piriform fossa. What is the most likely diagnosis?
D. Third or fourth branchial pouch sinus, most commonly a fourth-pouch anomaly
A congenital piriform-fossa sinus creates recurrent left-sided infection around the thyroid. Acute sepsis is treated first; definitive endoscopic obliteration or tract surgery follows specialist mapping.
Why every option is right or wrong
A. Thyroglossal duct cyst: This produces a midline mass moving with tongue protrusion.
B. Second branchial cyst: This typically lies lateral to the carotid space and does not open at the piriform apex.
C. Cystic hygroma: A lymphatic malformation does not cause recurrent suppurative thyroiditis through a mucosal tract.
D. Third or fourth branchial pouch sinus, most commonly a fourth-pouch anomaly: A congenital piriform-fossa sinus creates recurrent left-sided infection around the thyroid. Acute sepsis is treated first; definitive endoscopic obliteration or tract surgery follows specialist mapping.
E. Dermoid cyst: This is usually a midline developmental mass without an internal pharyngeal opening.
What if the scenario changed?
If acute abscess and airway compromise were present, drainage and airway management would precede definitive tract treatment.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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