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Thornwaldt Cyst                                           


  1. A common, benign midline nasopharyngeal mucosal cyst
  2. Often found incidentally during flexible fiberoptic endoscopy 
  3. Although typically asymptomatic, infected cysts can cause halitosis, extrusion of infected fluid, or eustachian tube obstruction. 


  1. Approximately 4% of the general population is found to have Thornwaldt cysts on autopsy  
    1. However, only 0.6% of the population demonstrates Thornwaldt cysts identifiable via imaging
      1. The reason for the discrepancy between autopsy and imaging is still not understood  
  2. Age ranges are quite variable with most occurring between 15-60 years of age
  3. Clinically apparent cysts usually appear during the 2nd to 3rd decades with males and females being equally affected.



  1. The nasopharynx is a compartment that extends from the base of the skull to the soft palate
  2. "Thornwaldt's bursa" is a midline nasopharyngeal recess formed from remnants of the embryologic notochord
  3. The normal mucosa of the posterior nasopharynx contains respiratory epithelia, lymphoid tissue, and minor salivary glands
  4. Respiratory epithelium (pseudostratified ciliated epithelium) becomes entrapped in the cyst cavity, leading to the accumulation of fluid.  



  1. Imaging frequently reveals a soft tissue mass with sharply defined boundaries in the posterior nasopharynx 
  2. Both CT and MRI can be used 
    1. MRI has a higher specificity and allows for more specific characterization of these lesions 
    2. T2-weighted imaging demonstrates high signal intensity while T1-weighting may be show less intensity 
  3. Imaging of Thornwaldt cysts should not have surrounding soft tissue reaction or bony involvement  

Differential Diagnosis:

  1. Adenoid retention cyst 
  2. Nasopharyngeal carcinoma
  3. Meningocele
  4. Neuroenteric cyst
  5. Sphenoid sinus mucoceles 
  6. Branchial cleft cyst 


  1. Asymptomatic cysts do not require treatment 
  2. Trans-nasal endoscopic marsupialization can allow for drainage of infected and/or enlarging cysts
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