Branchial cleft cyst

Case contributed by Dr Smita Deb

Presentation

Right-sided fluctuant swelling of the neck. Past history of branchial cleft cyst partially removed. Previously infected lymph node and trigeminal neuralgia.

Patient Data

Age: 38
Gender: Male
Modality: CT

Deep to the right SCM muscle sternocleidomastoid is a relatively low density ?cystic mass, separate to the parotid gland and carotid sheaths, (20 x 25 x 17 mm) ~20 Hounsfield units.

The mass is well circumscribed and superiorly appear to be a number of branching or tubular structures of similar density, which is atypical for a branchial cleft cyst. No fat stranding seen around the mass.

A couple of lobulated lesions,  of somewhat lower density (-20 HU) are seen between the anterior border of SCM and the overlying skin.

Modality: MRI

• Large cystic mass seen centred in the right perivertebral compartment (6.8 x 2.7 x 6.2cm).

• Large septated cystic component with many smaller complex cystic elements, extending to the region of the right carotid sheath and posterior parotid region.

• There are further smaller cystic components in the subcutaneous fat within the lateral neck.

• Thin peripheral enhancement, including in the septation within the large cystic component.

Case Discussion

Case submitted by Dr Smita Deb and A/Prof Pramit Phal.

Initially a CT neck was done with the differential diagnoses being: branchial cleft cyst vs veno-lymphatic malformation.

However, given the variegated cystic appearance on MRI as well as the branching structures near the mass on CT (atypical for branchial cleft cyst), a venolymphatic malformation is favoured over a complicated branchial cleft cyst.

USS + FNA was done which confirmed a branchial cleft cyst.

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Case Information

rID: 31167
Case created: 22nd Sep 2014
Last edited: 27th Sep 2015
System: Head & Neck
Inclusion in quiz mode: Included

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