Medically reviewed by Edward Tavel, MD, Medical Director · Last reviewed 22 August 2026
A Tornwaldt cyst, also spelled Thornwaldt, is a small fluid-filled pocket that sits in the midline at the roof and back wall of the nasopharynx, the space directly behind the nasal cavity and above the soft palate. It forms from a developmental remnant. During early development, a brief connection exists between the notochord and the lining of the pharynx, and when that connection does not fully regress, a small pouch is left behind that can fill with mucus. It is present from birth, though it usually goes unnoticed for a lifetime.
Tornwaldt cysts are among the more frequently encountered incidental findings on head and neck MRI. Autopsy series report them in roughly 1% to 4% of people, and imaging series report similar or somewhat higher rates depending on the population studied. There is no meaningful difference between men and women. The overwhelming majority produce no symptoms whatsoever and are discovered only because the nasopharynx happened to fall within the imaged field of a scan ordered for another reason, which places them squarely in the category of incidental findings.
On MRI, a Tornwaldt cyst appears as a well-defined, rounded midline structure that is bright on T2-weighted images because of its fluid content. Its appearance on T1-weighted images is more variable, ranging from dark to strikingly bright depending on how much protein and mucus the fluid contains. That variability is a shared characteristic of many mucus-containing cysts throughout the body and is the same principle described in our entry on the proteinaceous cyst. Its consistent midline position is the feature that most reliably identifies it and separates it from other nasopharyngeal lesions, which tend to sit off-center.
Because they are almost always asymptomatic, Tornwaldt cysts generally require no treatment at all, and observation is the standard approach. A minority become symptomatic, usually when the cyst is larger or has become infected. In those cases people may report persistent postnasal drip, an unpleasant taste or breath odor, nasal obstruction, a dull occipital headache at the back of the head, or a sense of fullness in the ear from pressure on the Eustachian tube opening. Symptomatic cysts are typically treated endoscopically with marsupialization, an outpatient procedure that opens the pouch so it can drain, and recurrence afterward is uncommon.
A Tornwaldt cyst on a report is almost always a footnote rather than a finding of concern. If you have questions about what a comprehensive scan covers and how incidental results are handled, review our frequently asked questions.
Frequently asked questions
Is a Tornwaldt cyst dangerous?
No. It is a benign developmental remnant and does not become cancerous. In the great majority of people it causes no symptoms and needs no treatment.
Why was it found if I have no symptoms?
The nasopharynx lies within the imaged area of most head, neck, and brain MRI studies. Tornwaldt cysts are usually discovered by chance during scans ordered for unrelated reasons.
Can it cause headaches or ear problems?
Occasionally. A larger or infected cyst can produce occipital headache, ear fullness, postnasal drip, or bad breath by pressing on the Eustachian tube opening or draining into the throat. This is the exception rather than the rule.
Does it need to be removed?
Only if it causes symptoms. When treatment is needed, endoscopic marsupialization opens the cyst so it can drain, and it is generally an outpatient procedure with a low recurrence rate.
Will it grow over time?
Most remain stable throughout life. If a cyst enlarges or becomes symptomatic, an ear, nose, and throat specialist can evaluate whether treatment is warranted.
Sources
A whole-body MRI at MRI Wellness looks at the brain, spine, chest, abdomen and pelvis in a single session, without radiation or contrast dye. No referral is needed.
