Tornwaldt Cyst
A Tornwaldt cyst is a benign, fluid-filled sac located at the back of the nasal passage where it connects to the throat. This finding on your radiology report is typically nothing to worry about. Most of these cysts cause no symptoms and require no treatment. This article explains exactly what Tornwaldt cysts look like on imaging studies, when they might cause problems, and what you should know if one appears on your medical report.
What Is a Tornwaldt Cyst?
A Tornwaldt cyst is a fluid-filled sac that develops in an area called the nasopharynx—the upper part of the throat behind the nose. These cysts form when a small pouch in the nasopharyngeal tissue becomes blocked and fills with mucus.
Most Tornwaldt cysts develop during fetal development but may not be discovered until adulthood when they appear on imaging studies done for other reasons.
How Common Are Tornwaldt Cysts?
Tornwaldt cysts are relatively uncommon, affecting about 3% of the general population. Many people who have these cysts never experience symptoms, which is why they often go undetected throughout life unless discovered accidentally during imaging studies for unrelated conditions.
Tornwaldt Cyst Symptoms
Most Tornwaldt cysts remain asymptomatic, meaning they don’t cause any noticeable problems. However, when symptoms do occur, they may include:
- Bad breath (halitosis)
- Persistent post-nasal drip
- Chronic nasal discharge
- Neck pain or stiffness
- Headaches at the back of the head
- Recurrent sore throat
- Difficulty swallowing in some cases
Symptoms typically appear when the cyst becomes infected or inflamed, which can happen after respiratory infections or trauma to the nasopharyngeal area.
How Tornwaldt Cysts Appear on Imaging
MRI Findings
Magnetic Resonance Imaging (MRI) is the most effective way to visualize a Tornwaldt cyst. On MRI scans, these cysts typically appear as:
- Well-defined, round or oval-shaped structures
- Located in the midline of the nasopharynx
- High signal intensity (bright) on T2-weighted images due to fluid content
- Variable signal on T1-weighted images depending on protein content
- Typically measure between 2-10 millimeters in diameter
CT Scan Appearance
On Computed Tomography (CT) scans, Tornwaldt cysts may be:
- Less clearly visible than on MRI
- Appear as smooth, round, low-density lesions
- Located in the midline of the posterior nasopharyngeal wall
- Generally homogeneous in appearance
- Sometimes missed on CT scans if they’re small
Nasopharyngoscopy Visualization
Though not an imaging study in the traditional sense, when viewed through a nasopharyngoscope (a thin, flexible tube with a camera inserted through the nose), Tornwaldt cysts appear as:
- Smooth, dome-shaped bulges
- Usually covered by normal-looking mucosa
- Sometimes with a small central dimple or opening
- May show signs of inflammation if infected
Differential Diagnosis: What Else Could It Be?
When radiologists identify a midline nasopharyngeal lesion, they consider several possibilities besides a Tornwaldt cyst:
Nasopharyngeal Carcinoma
Unlike the smooth, well-defined Tornwaldt cyst, nasopharyngeal carcinomas typically:
- Have irregular borders
- Show evidence of invasion into surrounding tissues
- Enhance with contrast
- May be associated with enlarged lymph nodes
Adenoid Tissue
Especially in children and young adults, prominent adenoid tissue can sometimes be mistaken for a cyst, but adenoids:
- Appear more diffuse and less well-defined
- Show enhancement with contrast
- Not fluid-filled
Treatment Options for Tornwaldt Cysts
For asymptomatic Tornwaldt cysts discovered incidentally on imaging:
- No treatment is necessary
- Regular monitoring may be recommended in some cases
For symptomatic cysts:
- Antibiotics if the cyst becomes infected
- Surgical marsupialization (creating an opening in the cyst to drain it)
- Endoscopic removal for persistent or problematic cysts
When to Seek Medical Attention
If your radiology report mentions a Tornwaldt cyst, there’s usually no cause for concern. However, consult a doctor if you experience:
- Persistent bad breath that doesn’t improve with good oral hygiene
- Chronic post-nasal drip that doesn’t respond to medications
- Recurrent infections in the throat or nasopharyngeal area
- Severe or worsening headaches at the back of the head
- Changes in the size or appearance of the cyst on follow-up imaging
Long-term Outlook
The prognosis for individuals with Tornwaldt cysts is excellent. These benign lesions rarely cause significant problems and don’t become cancerous. Even symptomatic cysts respond well to treatment, and recurrence after surgical intervention is uncommon.
Conclusion
Tornwaldt cysts are small, fluid-filled sacs in the nasopharynx and are generally harmless. Most remain asymptomatic throughout life and require no treatment. For the small percentage of people who develop symptoms, effective treatments are available. If you have questions about a Tornwaldt cyst mentioned in your radiology report, discuss them with your doctor who can provide guidance based on your specific situation.
References
- https://www.icliniq.com/articles/ent-health/tornwaldt-cyst
- https://radiopaedia.org/articles/tornwaldt-cyst-3?lang=us
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7550824/