梨狀窩瘻管併發急性化膿性甲狀腺炎－病例報告

由於甲狀腺對於細菌感染有頗高的抵抗性，急性化膿性甲狀腺炎與甲狀腺膿瘍是臨床上相當少見的甲狀腺疾病。其發生原因依據新近的文獻報告，常與先天性梨狀瘻管有關。本報告為23歲女性病患，因發燒多日、左前頸部紅腫並有明顯觸痛以及心悸數日而入院診治。經超音波與電腦斷層掃描顯示左葉甲狀腺與甲狀腺周圍膿瘍，細針抽取細胞學與其他實驗室檢驗數據呈現急性感染相與甲狀腺功能亢進。經抗生素治療與手術引流後症狀緩解，術中並一癭由左葉甲狀腺往上延伸。經食道鋇劑X光攝影顯示一左側梨狀窩瘻管。再行瘻管切除術與左葉甲狀腺切除後追蹤至今達1年以並上，無復發情形，也無喉返神經麻痺，甲狀腺功能亦呈正常。我們相信梨狀窩瘻管為引起急性化膿性甲狀腺炎與膿瘍的主因，並與先天性鰓裂或鰓囊異常有關。而暫時性甲狀腺功能抗進乃由急性化膿性甲狀腺炎引起。

關鍵字

梨狀窩瘻管；急性化膿性甲狀腺炎；甲狀腺功能亢進

並列摘要

Acute suppurative thyroiditis with abscess is a rare disease because of the resistance of the thyroid gland to bacterial infection. Congenital piriform sinus fistula has been reported as a cause of acute suppurative thyroiditis and deep neck abscess. A 23-year-old woman presented with fever, a progressively swollen, tender, erythematous mass over the left anterior neck, and palpitation for several days. Abscess of the left thyroid gland and perithyroid space was noted by sonography and neck computed tomography. Laboratory examinations showed acute infection and hyperthyroidism. The symptoms and signs improved after intravenous antibiotics injections and surgical drainage. A fistulous structure was found in the thyroid gland during surgery. Barium-meal esophagography was performed then, and a fistula from the apex of the left piriform sinus to the thyroid tissue was noted. A complete fistulectomy and left lobectomy of the thyroid gland was performed. After more than one year of follow up, there has been no recurrence or paralysis of the left recurrent laryngeal nerve, and thyroid function has been normal. The patient is not taking any medication. We propose that piriform sinus fistula resulting from a congenital anomaly of the branchial cleft or pouch was the cause of the acute suppurative thyroiditis with abscess. Hyperthyroidism was transient in this case and resulted from acute infectious inflammation of the thyroid gland.

並列關鍵字

piriform sinus fistula ； acute suppurative thyroiditis ； hyperthyroidism

國際替代計量

梨狀窩瘻管併發急性化膿性甲狀腺炎－病例報告

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