A Case of Neonatal Pyriform Sinus Cyst Presenting With Respiratory Distress

TL;DR

A newborn with a rare pyriform sinus cyst causing breathing issues was successfully treated with surgery after initial imaging and aspiration failed to fully resolve the problem.

Contribution

This paper presents a novel clinical case emphasizing the importance of early diagnosis and surgical intervention for neonatal pyriform sinus cysts.

Findings

A pyriform sinus cyst in a neonate was diagnosed using CT and confirmed by histology after aspiration failed.

Surgical excision resolved the airway obstruction, though transient vocal cord paralysis occurred.

Follow-up MRI showed no recurrence, highlighting the effectiveness of timely surgical intervention.

Abstract

Pyriform sinus cysts are rare congenital anomalies originating from the third or fourth branchial pouch that can cause neonatal airway obstruction. We report the case of a male neonate born at 38 weeks of gestation who developed respiratory distress at birth. Physical exam revealed subcostal retractions and nasal flaring, but no stridor. Laryngoscopy on day 4 demonstrated a bulging posterior pharyngeal wall, and computed tomography (CT) identified an air-filled cyst extending into the left neck, suggestive of a pyriform sinus cyst. Ultrasound (US)-guided aspiration of 7 mL of fluid temporarily relieved symptoms; however, recurrence necessitated surgical excision on the seventh day of life. The cyst and two fibrous cords were removed. Histology analysis confirmed infection with chronic inflammation and granulation tissue. The patient developed transient left vocal cord paralysis, which resolved within three months. Follow-up magnetic resonance imaging (MRI) showed no recurrence. This case highlights the importance of early diagnosis and surgical intervention to prevent airway obstruction, while emphasizing the roles of imaging, nerve preservation, and postoperative monitoring. Further research into minimally invasive techniques and prenatal diagnosis is warranted.

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