MedPix® Patient Chart - Case No: 8147 :: - Review Images

Large, tender neck mass. Upper respiratory infection 10 days prior.

Large, soft neck mass along anterior left neck. Afebrile, otherwise healthy.

- Review Images for PT: 8147

Contrast enhanced neck CT demonstrates a large, fluid-attenuation mass anteriomedial to the anterior margin of the left sternocleidomastoid muscle, lateral to the carotid vessels. Minimal rim enhancement. No associated solid components.

- Review Images for PT: 8147

Lymphadenopathy (reactive, neoplastic, lymphoma, metastasis)
Branchial cleft cyst
Abscess
Granulomatous disease
Lymphatic malformation (cystic hygroma)

- Review Images for PT: 8147

Dx: Second branchial cleft cyst

Dx Confirmed by: Surgical excision.

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None.

See factoid.
Embryology Review:

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A branchial cleft cyst is a developmental abnormality arising from incomplete closure of one of the five branchial apparati (branchial arch, cleft and pouch) between two and seven weeks gestational age. The result is a cyst, sinus or fistula lined with stratified squamous epithelium containing dermal appendages.

Five branchial arches, each with its own artery and nerve, develop into the structures of the head and neck. Developmental anomalies are recognized in the first, second third and fourth branchial clefts. Second branchial cleft anomalies are the most common and are seen in about 90%-95% of cases. They are seen along the anterior sternocleidomastoid muscle superior and lateral to the carotid artery and cranial nerves IX and XII. The cyst may open into the tonsillar fossa. First cleft anomalies (about 8%) are found in proximity to the external auditory canal and are classified based on the presence of any communication with it. Third cleft anomalies are rare. They involve the pyriform sinus and extend posterior to the carotid vessels. Fourth cleft anomalies are very rare, usually left sided, and extend in the mediastinum from the pyriform sinus.

Branchial cleft cysts are bilateral in 2-3% of cases. Cases tend to cluster in families. The cyst or fistula is usually an asymptomatic mass that appears early in life. Infection may occur, especially after upper respiratory infection. Uninflamed cysts are excised under general anesthesia. The recurrence rate is low.

Gills in fish and amphibians develop from primordial structures phylogenetically similar the branchial apparatus. The Greek word for gills is "branchia".