Radiology Teaching Files > Case 71814

Contributed by: Faculty and residents Children's Hospital, Radiologist, Children's Health System, Birmingham, Alabama., USA.
Patient: 5 year 4 month old male
History: History of a lump noticed on the left side of the neck. Has been painless over past month however two days ago the area became painful and erythemic.

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Findings: Cystic well defined mass adjacent to the angle of the mandible on the left. this is just adjacent to the sternocleidomastoid muscle. The cystic strucure has a thickened enhancing rim. There is associated nonspecific lymph nodes within the ipsilateral ant and post triangles of the neck.
Diagnosis: Infected Type II Branchial cleft cyst
Discussion: Branchial cleft cysts Results from failure of obliteration of cervical pouch. During the fourth week of embryological life there is development of the four branchial cleft resulting in five ridges(pharyngeal arches). The second arch grows caudally and covers the third and fourth arches. If the buried cleft does not involute completely then the entrapped remenant forms into an epithelial lined cyst and sometimes with a sinus tract to the skin. If this forms involving the first branchial cleft it is called a type I cyst and is located at level of EAC or parotid. If the second cleft is involved this is located at the angle of thte mandible and is considered a type II cyst. If a cleft develops with a tract to piriform sinus, posterior to carotid artery it is considered a type III cyst. Branchial cleft cysts are often asymptomatic however they can become infected and form abscesses. The imaging characteristics reveal a cystic mass on ultrasound or CT. If the cyst is infected the wall become thick and enhance. Differential considerations include cystic hygroma, lymphangioma, hemangioma, inlfamed/necrotic lymph node,teratoma, and thymic cyst. treatment involves surgical excision. It is best to delay surgey until three months of age. recurrance rate is 3%.

The Requisites Pediatric Radiology HAns Blickman. Second Edition, copyright 1998 by Mosby, Inc.
Primer of Diagnostic Imagin Ralph Weissleder, Mark J. Rieumont, Jack Wittenberg. second edition. copyright 1997 by Mosby Inc.

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Additional Details:

Case Number: 71814Last Updated: 10-06-2003
Anatomy: Face and Neck   Pathology: Congenital
Modality: CTExam Date: 04-21-2003Access Level: Readable by all users

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