Infected 4th branchial cleft cyst
Right neck swelling, fever.
CT neck with contrast
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The right lobe of the thyroid gland is expanded by a complex cystic lesion showing intra- and peri-thyroid extensions. It is dissecting through strap muscles, extending into the retropharyngeal space as well as the lower portions of infrahyoid carotid space, parapharyngeal and posterior cervical spaces. It displaces the right common carotid artery and the trachea to the right side.
The presented case shows radiological features of a right neck trans-spatial abscess within the right lobe of the thyroid gland that is probable for an infected fourth branchial cleft cyst. Fourth branchial cleft cysts are a rare type of branchial cleft cyst that occur 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 thyroid gland.