Case of Tornwaldt’s Cyst reported in NEJM

Dr Chien-Yu Huang, and Dr Bor-Hwang Kang, at Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan have reported a case of Tornwaldt’s Cyst that has appeared in the New England Journal of Medicine.

Tornwaldt cyst or Thornwaldt cyst or Nasopharyngeal cyst represents the remnant of the notochord. It is usually small and accidentally diagnosed on MRI. The large sized cyst may present with nasal, ear or cervical symptoms including obstructive symptoms. Tornwaldt cysts occur in the midline bursa of the nasopharynx above the upper border of the superior constrictor muscle. Recurrent nasopharyngeal infection and trauma are a common etiological factor. Surgical intervention requires in symptomatic patient irrespective of its size.

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 tumour 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.