Infected second branchial cleft cyst

Case contributed by Ammar Haouimi
Diagnosis probable


Painful swelling of the right upper neck.

Patient Data

Age: 45 years
Gender: Female

The ultrasound images demonstrate a well-circumscribed ovoid homogeneously hypoechoic cystic lesion with internal debris and posterior acoustic enhancement. This cystic lesion is separated from the adjacent submandibular gland (SMG).

The previously described cystic lesion appears lobulated of slightly high signal on TWI, high signal on T2WI with thick enhancing wall on postcontrast sequences, and restricted diffusion on DWI/ADC. This lesion is located, below the parotid gland, anterior to the sternocleidomastoid muscle (SCM), posterior to the submandibular gland, and lateral to the carotid bifurcation, and internal jugular vein. Small enlarged lymph nodes are noted.

Case Discussion

The ultrasound and MRI features are suggestive of an infected second branchial cleft cyst

The differential diagnosis should include:

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