Infected branchial cleft cyst
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Large cystic lesion at the right submandibular region with the following criteria:
- measures 5 x 4.5 cm in axial dimensions and 6 cm CC
- low signal on T1, a high signal on T2 and restricted diffusion
- displaces the left submandibular gland anterior
- post contrast series revels marginal enhancement of the cyst with an associated abnormal signal of the overlying sternomastoid muscle with lateral displacement as well as intramuscular enhancing fluid-filled pockets of its anterior margin
- abnormal subsequent medial displacement of the left carotid sheath with preserved signal void character
- restricted diffusion
Multiple bilateral reactionary lymph nodes are seen as well.
Aspiration of 20 cc of creamy fluid with cytological examination of the films and cell block prepared from the aspirate reveals keratinized squamous cells, polymorphonuclear leukocytes, macrophages, inflammatory cells and red blood cells. Cytology concludes secondary infected branchial cyst.