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Revisiting imaging features and the embryologic basis of third and fourth branchial anomalies.
AJNR Am J Neuroradiol. 2010 Apr; 31(4):755-60.AA

Abstract

BACKGROUND AND PURPOSE

There is wide discrepancy between common clinical and radiologic presentations of branchial sinuses arising from the pyriform fossa and the theoretic course of third and fourth branchial arch anomalies. The purpose of this study was to revisit the clinical presentations and imaging features of such anomalies in children.

MATERIALS AND METHODS

A retrospective review of institutional and diagnostic imaging data bases from 1998 to 2008 for reported cases of third and fourth branchial cleft anomalies was conducted. Clinical presentation, pharyngoscopy results, and imaging features in all the patients were evaluated. Surgical and histopathology correlation in patients who underwent excision of the tract was also obtained.

RESULTS

Twenty reported cases described as third or fourth branchial apparatus anomalies were identified. There were 12 females and 8 males with a mean age of 84.6 months. The most common presentation was an inflammatory neck mass (18/20, 90%) almost always involving the thyroid gland. Most lesions were on the left side (16/20, 80%). Pharyngoscopy showed a sinus opening at the piriform fossa in 18/20 (90%) cases. None of the cases followed the classic theoretic pathway of third and fourth arch remnants. Histopathology showed tracts lined with pseudostratified squamous epithelium or ciliated columnar epithelium often associated with inflammatory changes in 17 surgically resected cases.

CONCLUSIONS

Branchial sinuses arising from the pyriform fossa often present with an inflammatory neck mass involving the thyroid lobe, most often on the left side. Imaging and surgical findings suggest that they arise from the embryonal thymopharyngeal duct of the third branchial pouch, because they do not follow the hypothetic course of third or fourth arch fistulas.

Authors+Show Affiliations

Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20007720

Citation

Thomas, B, et al. "Revisiting Imaging Features and the Embryologic Basis of Third and Fourth Branchial Anomalies." AJNR. American Journal of Neuroradiology, vol. 31, no. 4, 2010, pp. 755-60.
Thomas B, Shroff M, Forte V, et al. Revisiting imaging features and the embryologic basis of third and fourth branchial anomalies. AJNR Am J Neuroradiol. 2010;31(4):755-60.
Thomas, B., Shroff, M., Forte, V., Blaser, S., & James, A. (2010). Revisiting imaging features and the embryologic basis of third and fourth branchial anomalies. AJNR. American Journal of Neuroradiology, 31(4), 755-60. https://doi.org/10.3174/ajnr.A1902
Thomas B, et al. Revisiting Imaging Features and the Embryologic Basis of Third and Fourth Branchial Anomalies. AJNR Am J Neuroradiol. 2010;31(4):755-60. PubMed PMID: 20007720.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Revisiting imaging features and the embryologic basis of third and fourth branchial anomalies. AU - Thomas,B, AU - Shroff,M, AU - Forte,V, AU - Blaser,S, AU - James,A, Y1 - 2009/12/10/ PY - 2009/12/17/entrez PY - 2009/12/17/pubmed PY - 2010/7/16/medline SP - 755 EP - 60 JF - AJNR. American journal of neuroradiology JO - AJNR Am J Neuroradiol VL - 31 IS - 4 N2 - BACKGROUND AND PURPOSE: There is wide discrepancy between common clinical and radiologic presentations of branchial sinuses arising from the pyriform fossa and the theoretic course of third and fourth branchial arch anomalies. The purpose of this study was to revisit the clinical presentations and imaging features of such anomalies in children. MATERIALS AND METHODS: A retrospective review of institutional and diagnostic imaging data bases from 1998 to 2008 for reported cases of third and fourth branchial cleft anomalies was conducted. Clinical presentation, pharyngoscopy results, and imaging features in all the patients were evaluated. Surgical and histopathology correlation in patients who underwent excision of the tract was also obtained. RESULTS: Twenty reported cases described as third or fourth branchial apparatus anomalies were identified. There were 12 females and 8 males with a mean age of 84.6 months. The most common presentation was an inflammatory neck mass (18/20, 90%) almost always involving the thyroid gland. Most lesions were on the left side (16/20, 80%). Pharyngoscopy showed a sinus opening at the piriform fossa in 18/20 (90%) cases. None of the cases followed the classic theoretic pathway of third and fourth arch remnants. Histopathology showed tracts lined with pseudostratified squamous epithelium or ciliated columnar epithelium often associated with inflammatory changes in 17 surgically resected cases. CONCLUSIONS: Branchial sinuses arising from the pyriform fossa often present with an inflammatory neck mass involving the thyroid lobe, most often on the left side. Imaging and surgical findings suggest that they arise from the embryonal thymopharyngeal duct of the third branchial pouch, because they do not follow the hypothetic course of third or fourth arch fistulas. SN - 1936-959X UR - https://www.unboundmedicine.com/medline/citation/20007720/Revisiting_imaging_features_and_the_embryologic_basis_of_third_and_fourth_branchial_anomalies_ L2 - http://www.ajnr.org/cgi/pmidlookup?view=long&pmid=20007720 DB - PRIME DP - Unbound Medicine ER -