Visual diagnosis: Swelling of the left side of the neck in an adolescent
Acute suppurative thyroiditis is rare, but clinicians should maintain a high degree of suspicion for this diagnosis when a patient presents with an acute, painful neck mass that moves with swallowing. Characteristic signs and symptoms include left-sided mass, often accompanied by fever, odynophagia, and dysphagia. CT scan and ultrasonography are useful for diagnosis. Antimicrobial therapy with broad coverage against oral grampositive organisms, gram-negative organisms, and anaerobes should be initiated empirically. Antibiotic therapy can be made more specific based on culture results but should continue to provide coverage of oral anaerobes. Evaluation for the presence of a pyriform sinus tract should be undertaken in a child who has had suppurative thyroiditis. If a pyriform sinus is discovered, it should be obliterated to prevent recurrent infection.
Pediatrics in Review
Varier, R., Plencner, L., Rivard, D., Myers, A. L. Visual diagnosis: Swelling of the left side of the neck in an adolescent Pediatrics in Review 32, 385-388 (2011).