Fig. 8

This 18-day-old baby presented with intermittent stridor. On examination, a left-sided oropharyngeal swelling was identified. The baby had initially required continuous positive airway pressure. Microlaryngobronchoscopy identified an internal opening arising from the pyriform sinus apex (black arrow; image courtesy of Mr Y. Bajaj). Axial and coronal T1 with coronal STIR imaging identified a likely air-containing structure (thick white arrows) extending from the pyriform sinus to the level of the left thyroid gland that was abnormally small (thin white arrow). This was surgically confirmed to represent a fourth branchial cleft sinus tract