Thursday, 15 March 2012

Thornwaldt's cyst MRI


Syn: Pharyngeal bursa, Thornwaldt bursa, Tornwaldt cyst.
A cystic density / signal intensity lesion at the roof of nasopharynx.
A developmental cyst, represent potential space developing in the nasopharynx at the point where the notochord retains its union with the pharyngeal ectoderm.

MRI is investigation of choice, signal intensity on MRI varies on both T1 and T2 weighted images depending up on its protein content and if any associated haemorrhage in the lesion.

The lesion is a mucosal cyst situated in the mid line between the longus capitus muscles, without associated inflammatory changes or edema in the surrounding soft tissues or without any adjacent bone involvement.

DDs:
Usually nil due to its typical location and imaging appearance. May include normal / prominent adenoidal tissue with cystic degeneration, mucous retention cyst.

Age group is second or third decades, no sex predilection.
Clinical symptoms:
Most often asymptomatic. Noted as an incidental findings on CT / MRI.
Symptoms may include postnasal drip, halitosis, headaches, eustachian tube dysfunction resulting in earache.

References:
1. Weissman JL. Thornwaldt cysts. Am J Otolaryngol 1992; 13: 381–5.
2. Miyahara H, Matsunaga T. Tornwaldt's disease. Acta Otolaryngol Suppl (Stockh) 1994; 517: 36–9.
3. Ikushima I, Korogi Y, Makita O, Komohara Y, Kawano H et al. MR imaging of Tornwaldt's cysts.AJR 1999; 172: 1663–5.
4. Goodwin RW. Tornwaldt's disease. Characteristics headaches syndrome and etiology. Laryngoscope 1944; 54: 66–75.
5.Chong VF, Fan YF. Radiology of the nasopharynx: pictorial essay. Australas Radiol 2000; 44: 5–13.
6. Battino RA, Khangure MS. Is that another Thornwaldt's cyst on MRI? Australas Radiol 1990; 34: 19–23.

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