Radiology Teaching Files > Case 8620448

Contributed by: Erin Cooke, Resident, Virginia Mason Medical Center, Washington, USA.
Patient: 20 year old male
History: Right sided neck mass x 3 months.

Fig. 1

Fig. 2
There is an oval, well circumscribed benign appearing low density lesion
located medial to the right sternocleidomastoid muscle. This measures
approximately 4.2 cm x 3.0 cm x  5.6 cm. No significant enhancement of this lesion is identified. This lesion
displaces the internal jugular vein medially with some compressive effect evident on the vein, although it is widely patent. No vascular invasion is identified.
Diagnosis: Second brachial cleft cyst.
Discussion: Branchial cleft cysts are congenital epithelial cysts, which arise on the lateral part of the neck from a failure of obliteration of the second branchial cleft in embryonic development.

Branchial cleft cysts are the most common congenital cause of a neck mass. An estimated 2-3% of cases are bilateral. A tendency exists for cases to cluster in families.


  • Many branchial cleft cysts are asymptomatic. They may become tender, enlarged, or inflamed, or they may develop abscesses, especially during periods of upper respiratory tract infection, due to the lymphoid tissue located beneath the epithelium. Spontaneous rupture of an abscessed branchial cleft cyst may result in a purulent draining sinus to the skin or the pharynx.
  • Depending on the size and the anatomical extension of the mass, local symptoms, such as dysphagia, dysphonia, dyspnea, and stridor, may occur.

Age: Branchial cleft cysts are congenital in nature, but they may not present clinically until later in life, usually by early adulthood.

Imaging Studies:

  • A sinogram may be obtained. If a sinus tract exists, radiopaque dye can be injected to delineate the course and to examine the size of the cyst.
  • Ultrasonography helps to delineate the cystic nature of these lesions.
  • A contrast-enhanced CT scan shows a cystic and enhancing mass in the neck. It may aid preoperative planning and identify compromise of local structures.
  • MRI allows for finer resolution during preoperative planning. The wall may be enhancing on gadolinium scans.
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Additional Details:

Case Number: 8620448Last Updated: 04-02-2007
Anatomy: Face and Neck   Pathology: Benign Mass, Cyst
Modality: CTAccess Level: Readable by all users

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