Infected 2nd branchial cleft cyst and fistula tract from tonsilits

Case contributed by Charlie Chia-Tsong Hsu


Left neck swelling.

Patient Data

Gender: Male
  • Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Coronal T1 and post con T1 FS images demonstrate a unilocular cyst with mild cystic wall and surrounding soft tissue enhencement. In addition there is enlargement of left tonsil with partial effacement of the pharyngeal mucosal space. The left tonsil and surrounding tissue demonstrate heterogenous enhencement. Imaging appearance is consistent with left tonsilitis and peritonsillar cellulitis. 

T2 coronal images confirms the predominately fluid signal cystic lesion with debri layering in the dependent portion. A fistula tract is identified extending from the apex of the cystic lesion to the left faucial tonsil (white arrows). The soft tissue surrounding the cyst and the fistula tract is edematous and inflammed. 

Axial T2 FS, T1 FS and post con T1FS demonstrate the extent left tonsilitis and peritonsillar cellulitis. The red arrows points to the fistula tract terminating in the left tonsil. Normal vascular flow voids of the internal jugular veins.

Axial post con T1 FS at the level of the cystic lesion illustrate the anatomical relationship which typifies a 2nd branchial cleft cyst: lateral to the carotid space and anteromedial to the sternocleidomastoid muscle. 

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