Images in Clinical Medicine: Tornwaldt’s Cyst

Summary

  • 60yo M
  • c/c
    • presented to ENT
    • feeling of nasal obstruction & postnasal drip
    • developped 10y earlier & worsened path mo
    • foreign body in throat
    • worsened when lying flat
  • PEx
  • Ex
    • nasopharyngoscopy
      • smooth, pink, cystic mass(+)
    • CT
      • cystic tumor
  • Dx
    • Tornwaldt's cyst
  • Rx
    • marsupialization

Further

Terminology

Original

Figure

A 60-year-old man presented to the otorhinolaryngology clinic with a feeling of nasal obstruction and postnasal drip that had developed 10 years earlier and had worsened over the past month. He also had a sensation of a foreign body in his throat. Symptoms worsened when he was lying flat. On physical examination, no deviation of the nasal septum or hypertrophy of the inferior turbinates was detected. Nasopharyngoscopy revealed a smooth, pink, cystic mass in the midline of his nasopharynx, with no obstruction of the openings to the eustachian tubes (the image shows the view through the right naris). Computed tomography of the head revealed a 2.5 cm by 1.3 cm by 1.4 cm cystic tumor in the midline of the nasopharynx without intracranial extension. The findings were consistent with Tornwaldt’s cyst, a benign cyst that arises between the roof of the nasopharynx and the remnant of the notochord. Because the patient was symptomatic, he underwent surgical marsupialization of the cyst. On follow-up examination 3 months after surgery, he no longer had the sensation of a foreign body in his throat, his nasal symptoms were reduced, and there was no recurrence of the cyst.