Infected second branchial cleft cyst
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Painful right neck swelling.
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There is a well-defined cystic lesion in the right side of the neck, anterior to the right sternocleidomastoid muscle, indenting the inferior border of parotid gland and slightly compressing the internal jugular vein on its medial and anterior borders. It also results in anterior displacement of right submandibular gland.
The lesion has a relatively thick enhancing wall and measures about 22×18mm in diameter, with no signs of invasion into surrounding structures.
Prominent lymph nodes with maximum SAD of 8mm are seen in right side. (Level Ib, II)
Features on CT scan are most likely compatible with an infected second branchial cleft cyst. Although a congenital abnormality, they tend to present in early adulthood (10-40 years of age) often after minor trauma or infection.