First branchial cleft cyst

Case contributed by Chiara Francesca Rosa
Diagnosis certain


On inspection, it presented as a painless inflammatory mass in the parotid region with cervical symptoms .

Patient Data

Age: 50 years
Gender: Male

MPR images CT


A well defined, water attenuation, inflamed mass is noticeable at axial, coronal and sagittal images reconstructions, located in the right parotid gland

US images pre and post FNA


Anechoic cystic mass with faint internal debris and posterior enhancement. Doppler US shows no vascularity. The cyst was drained off after FNA

Salivary gland cyst can tipically be identified with ultrasound. FNA is a technique frequently utilized for diagnostic purposes, and when needed, can be used therapeutically to drain benign cyst. If FNA findings show non-mucinous aspirate with or without associated lymphocytes which can also be lined by squamous epitelium, an overall diagnostic accuracy of 84% can be demonstrated 1.

Case Discussion

First branchial cleft cyst can be situated superficial or deep to the parotid gland or along the external auditory canal 3.

It is a possible differential for neck's cystic lesion such as : parotitis with abscess formation, lymphatic malformation, parotid sialocele, bening lymphoephitelial cyst 2.

The managment includes surgery excision for definitive treatment because it do not regress spontaneously and have a propensity for recurrent infections 3.

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