A new role for computed tomography in the diagnosis and treatment of pyriform sinus fistula

Neck abscess located in or around the thyroid gland should raise the suspic ion of acute suppurative thyroiditis, pyriform sinus fistula, a 3rd or 4th branchial cleft anomaly. Differentiating between these entities on a clinic al basis is difficult. After treating the initial infection, computed tomog raphy, barium esophagography, ultrasound, and endoscopy can be used in sear ch of the fistulous tract that can be associated with a pyriform sinus fist ula or a 3rd or 4th branchial anomaly. We present a case of a pyriform sinu s fistula involving the use of oral contrast, combined with computed tomogr aphy, to delineate the tract and its surrounding structures. This method, i n combination with endoscopy, aided in the removal of this branchial anomal y.