Hypopharyngeal toothpick-induced granuloma mimicking a pyriform sinus malignancy

Abstract Adult foreign body ingestion is a common event. Here we present a case of toothpick ingestion resulting in a granulomatous reaction mimicking a piriform sinus malignancy. A 55-year-old male nonsmoker presented with a 3-month history of left sided neck pain, odynophagia and dysphagia. CT revealed a heterogeneous enhancement in the left piriform sinus. Direct laryngoscopy was performed, and biopsy of the mass revealed acute/chronic inflammation and granulation tissue with presence of a plant-based substance consistent with a toothpick. No evidence of malignancy was appreciated. Follow up CT scan at 5 months showed complete resolution of the mass.