First branchial cleft cyst (type 1)
4 year old male with a history of right sided postauricular mass.
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There is an oval well-circumscribed low T1 high T2 signal intensity cystic mass located posterior to the right pinna and concha, that measures 1.7 (AP) by 0.8 (transverse) by 1.6 (CC) centimeters. The mass does not demonstrate enhancement on the postcontrast images. No fistulous tract is identified.
The branchial apparatus develops during the second to sixth weeks of fetal life. The first branchial cleft develops into the external auditory canal. First branchial cleft cysts are subdivided base upon location: type I cysts are located near the external auditory canal usually inferior, posterior and medial to the tragus/pinna.
All types of 1st branchial cleft cysts are intimately associated with the facial nerve and the parotid gland. Clinical manifestations range from a palpable mass to those associated with infection.
The main differential diagnostic consideration in our case is a lymphatic malformation.
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