A pediatric case of abscessed thyroiditis: unveiling an unexpected etiological discovery

Heyfa Belhadj-Miled; Houas Jihene; Monia Ghammam; Oussama Khalfi; Omri Malika El; Abir Meherzi; Mouna Bellakhdhar; Wassim El Ghali; El Abed Yosra Hasni; Wassim Kermani; Mohamed Abdelkafi

doi:10.1530/endoabs.99.EP139

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Endocrine Abstracts (2024) 99 EP139 | DOI: 10.1530/endoabs.99.EP139

ECE2024 Eposter Presentations Thyroid (198 abstracts)

A pediatric case of abscessed thyroiditis: unveiling an unexpected etiological discovery

Heyfa Belhadj-Miled ¹ , Houas Jihene ¹ , Monia Ghammam ¹ , Oussama Khalfi ² , Malika El Omri ¹ , Abir Meherzi ¹ , Mouna Bellakhdhar ¹ , El Ghali Wassim ³ , Yosra Hasni El Abed ⁴ , Wassim Kermani ¹ & Mohamed Abdelkafi ¹

Err

Author affiliations

¹Farhat Hached Hospital, ENT dapartment, Sousse, Tunisia; ², department of radiology, Sousse, Tunisia; ³, Department of Anaesthesia, Sousse, Tunisia; ⁴, Department of Endocrinology, Sousse, Tunisia

Introduction: Thyroid abscess in the pediatric population is an uncommon presentation and the rarest form of thyroiditis. Anomalies of the third and fourth branches account for 2-8% of cases. Through the observation of febrile torticollis secondary to an acute suppurative thyroiditis, we describe our diagnostic and etiological approach and specify its therapeutic management.

Materials and Methods: We present a rare case of an abscessed thyroiditis complicated by febrile torticollis, reported in our ENT Department.

Results: The patient is a 6-year-old with no significant medical history, presenting with febrile torticollis and a left basicervical swelling evolving for ten days. Examination revealed a febrile swelling in the left lateral thyroid compartment, measuring 5 cm in the major axis, firm, painful, with inflammatory signs. The rest of the ENT and general examination showed no anomalies except for a fever of 39°C. Ultrasound demonstrated an irregular oval mass with lobulated contours, measuring 54×1 mm, multilocular, located in the left basicervical region, pushing back the ipsilateral carotid axis and the left lobe of the thyroid. Cervical CT revealed a lobulated and multilocular mass in the left lateral and basicervical region, measuring 54×42×57 mm. Posteriorly, it extended into the retropharyngeal space, causing bulging of the left lateral wall of the hypopharynx and reducing the lumen of the ipsilateral piriform sinus. Esophageal transit revealed the presence of an opacified fistulous tract originating from the left piriform sinus. Hypopharyngoscopy showed a small fistulous opening at the bottom of the left piriform sinus, leading to the diagnosis of a fourth branchial cleft cyst. The initial treatment involved incision and drainage combined with intravenous antibiotic therapy. Subsequently, after resolution of the infectious episode, cyst excision was performed along with left lobo-isthmectomy and cauterization of the fistulous opening with silver nitrate. The patient’s evolution was favorable with a one-year follow-up.

Conclusion: Febrile torticollis in children is an infrequent reason for consultation. It can be the revealing pattern of extremely rare ENT pathologies, including congenital cervical anomalies in children.