Radiology Teaching Files > Case 459220

Contributed by: Children's Hospital Omaha, Radiologist, Omaha Childrens, Creighton University and UNMC, Nebraska, USA.
History: Halitosis

Fig. 1: Axial non-contrast T2-weighted (MR) shows a well defined cyst located between the longus coli muscles. There is increased signal intensity secondary to the high protein secretions.

Fig. 2: Axial T2-weighted shows hyperintense cyst.
Diagnosis: Tornwaldt (Thornwaldt Cyst)
Discussion: Tornwaldt (Thornwaldt Cysts) are benign developmental lesions in the nasopharynx. Peak incidence is 15 to 30 years of age. Develop secondary to anomalous embryogenesis of the cephalic end of the notochord. Initially, the notochord descends into the nasopharynx. Subsequently it ascends into the skull base when adherence develops between the notochord and the overlying ectoderm. A small portion of the nasopharyngeal mucosa is sometimes covered along with the notochord as it ascends. This results in a cyst lined with nasopharyngeal mucosa between the longus coli muscles. The cyst fluid is highly proteinaceous. The cysts are usually asymptomatic and are coincidental findings. Occasionally, these are associated with halitosis, persistent nasal discharge and a bad taste. When infected they can cause a retropharyngeal abscess.

Castillo M, Mukherji S. In Imaging of the Pediatric Head, Neck and Spine. Philadelphia: Lippincott-Raven, 1998: 578-580.

Contributed by: Kyle Reynolds, Bachelor of Science, Chadron State College, Chadron, NE
Philip Silberberg. M.D., Pediatric Radiologist, Omaha Childrens Hospital, Omaha, NE

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Additional Details:

Case Number: 459220Last Updated: 09-21-2004
Anatomy: Face and Neck   Pathology: Congenital
Modality: CT, MRExam Date: Access Level: Readable by all users
Keywords: tornwaldt (thornwaldt) cyst

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