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Head and Neck Imaging

Tornwaldt's cyst

(Gustav Ludwig Thornwaldt, 1843-1910, German physician),(also called bursa pharyngea), a cystic notochordal remnant in the posterior nasopharyngeal wall, present in about 3% of the population. The cyst is located in the midline, between the prevertebral muscles. Most are asymptomatic, but they may occasionally cause nasal discharge, halitosis or other symptoms. They may become infected, causing prevertebral muscle spasm and a foul-smelling nasal discharge. A Tornwaldt's cyst appears as a hypodense cystic lesion on CT images; on MRI, the signal intensity is often rather high on T1-weighted images, presumably because of a high protein content (Fig. 1). The differential diagnosis is a retention cyst in the nasopharyngeal mucosa.

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Fig. 1a

Axial T1-weighted spin-echo image. Sharply demarcated, high signal intensity structure (arrowhead) in the posterior nasopharyngeal midline.
Tornwaldt's cyst, Fig. 1a