Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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March 14, 2011
Infected Remnant of 2nd Branchial Cleft Cysts
- Second Branchial Cleft cysts account for >90% of branchial cleft anomalies.
- They most commonly present at the mandibular angle; however, they can occur anywhere along the potential space from the faucial tonsil to the supraclavicular fossa, the anterior to the sterno-cleidomastoid muscle.
- If the entire track is not resected, the child may present with infection of the remnant at a later time, as shown in this case.
- Key Diagnostic Features: Non-infected cyst is typically seen as a non-enhancing cystic structure posterolateral to the submandibular gland, anteromedial to the sternocleidomastoid muscle, and lateral to the carotid sheath. Infected cyst will demonstrate enhancement of the walls and stranding of the adjacent fat. Fistulous tract extending from the faucial tonsil to the lower neck, anteromedial to sternocleidomastoid muscle can occasionally be seen.
- DDx: Lymphangioma, necrotic or cystic nerve sheath tumors, epidermoid or dermoid cysts, or suppurative nodes
- Treatment: Surgical resection
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