Presentation
On and off serous discharge from midline upper neck since many years.
Patient Data
The midline cutaneous opening in the infrahyoid neck was cannulated and 1 cc of water-soluble contrast was injected.
The fistulous tract extended superiorly from midline infrahyoid region, coursing along the anterior surface of hyoid bone and is seen extending up to the foramen cecum of the tongue. The tract measures 4.0 cm in length and 1.9 mm in diameter. There is mild dilatation of the tract at the level of cutaneous opening measuring 5.0 x 2.8 mm. These features are consistent with thyroglossal duct fistula.
There is a blind-ending secondary oblique ramification of the tract in the tongue towards the left side. The secondary tract measures 1.3 cm in length and 2.0 mm in diameter.
No midline cystic lesion is seen in the neck. No significant lymphadenopathy.
Case Discussion
Thyroglossal duct fistulae have a typical course, extending up to the foramen cecum of the tongue. It can be associated with a thyroglossal cyst.
MRI can be helpful in the presence of active discharge from the external opening. CT fistulogram will help define the entire length of the tract. In some cases, both CT and MRI are complementary to each other.
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