Infected 4th branchial cleft cyst
Clinically suspected left neck abscess.
CT neck with contrast
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An abscess is noted involving the upper pole of the left lobe of thyroid gland extending to ipsilateral carotid and retropharyngeal spaces. It is measuring about 2.5 x 4.5 cm in axial dimensions surrounded by deep space cellulitis. It is involving the left sternomastoid muscle with muscle enlargement and interstitial edema.
The radiological features are suggestive of abscess at the left side of the neck near thyroid gland with the possibility of an infected fourth branchial cleft cyst and abscess formation. Fourth branchial cleft cyst is a rare branchial cleft cyst which occurs along the course of the recurrent laryngeal nerve. It is most commonly on the left side (80%) and commonly located adjacent to the thyroid gland. The most common presentation is abscess within or anterior to the left thyroid lobe.