Tornwaldt's cyst cyst (sist)
is an uncommon type of nasopharyngeal cyst that may cause clinically significant symptoms. We reviewed reports of 31,855 computed tomography (CT) scans and 21,158 magnetic resonance imaging (MRI) scans to ascertain how many Tornwaldt's cysts were discovered incidentally. These images had been obtained between Jan. 1, 1994, and Dec. 31, 1999, at the University of Virginia Health Sciences Center. We found that 32 Tornwaldt's cysts had been incidentally detected in 20 women and 12 men. Four of these cysts had been found on CT (0.013%; mean size: 0.66 [cm.sup.3]) and 28 on MRI (0.13%; mean size: 0.58 [cm.sup.3]). The overall rate was 0.06% (32/53,013). The most common indications for imaging in these patients were headache, seizures, dizziness/vertigo, and pharyngeal symptoms. We also report the case of a patient with a symptomatic Tornwaldt's cyst whose symptoms resolved after treatment with endoscopic marsupialization. Tornwaldt's cyst should be remembered as an uncommon but potentially treatable cause of many symptoms seen in a typical otolaryngology practice.
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The incidence of Tornwaldt's cyst as detected by MRI and CT of the head is low. Because these cysts are so uncommon, they may go undiagnosed as the source of several common ENT complaints. However, imaging, especially MRI of the nasopharynx, can detect even a small Tornwaldt's cyst, and therefore it should be considered when such a diagnosis seems plausible. When a diagnosis of Tornwaldt's cyst is established, surgical marsupialization of the cyst can lead to the resolution of symptoms in selected patients.
