Abstract
INTRODUCTION AND IMPORTANCE: Thornwaldt's cysts are benign nasopharyngeal anomalies that are often asymptomatic but can present diagnostic challenges and potential complications, necessitating clinical vigilance. Although these cysts are typically benign, their incidental discovery requires careful evaluation, particularly in asymptomatic patients with co-morbid conditions such as chronic kidney disease (CKD). This case underscores the importance of comprehensive imaging and ongoing monitoring for proper management of such nasopharyngeal anomalies. CASE PRESENTATION: We present the case of a 28-year-old man with CKD who was incidentally diagnosed with a Thornwaldt's cyst while being evaluated for recurrent epistaxis and dizziness. Initial clinical examination revealed nasal turbinate hypertrophy but with normal nasal patency. Magnetic resonance imaging of the brain and nasopharynx revealed a clearly defined, small cystic mass (1.1 × 1.2 cm) located on the posterior nasopharyngeal wall. CLINICAL DISCUSSION: Thornwaldt's cysts generally have a favorable prognosis with conservative management. However, periodic imaging and clinical evaluation are essential to detect any symptomatic progression or complications that may require surgical intervention. Although the cyst was relatively large in comparison to typical literature reports, its benign nature, along with the patient's lack of symptoms, allowed for conservative management. Given the patient's underlying CKD, close monitoring was recommended to detect any changes in size or potential complications, including the development of obstructive symptoms or infection. CONCLUSION: Diligent monitoring through routine imaging is crucial for detecting and managing incidental findings such as Thornwaldt's cysts, especially in patients with underlying health conditions like CKD. Routine follow-ups are necessary to ensure early intervention if symptoms develop or if the cyst changes in size, ensuring timely management of any potential complications.