Second branchial cleft cyst

Case contributed by Dr Fadi Aidi


Painless slow growing right sided neck mass.

Patient Data

Age: 30 years
Gender: Male

Right-sided neck cystic structure is seen as a sharply marginated, ovoid with fine internal echoes, representing debris, it has a thin peripheral wall that displaces the surrounding soft tissues. The lesion shows acoustic enhancement. The cyst is closely related and displace the ICA and ECA, no internal vascularity, no soft tissue nodules or wall thickening.


At CT, the cyst is typically well-circumscribed, homogeneously hypoattenuating mass surrounded by a uniformly thin wall.  The location of the cyst is at the anteromedial border of the sternocleidomastoid muscle, lateral to the carotid space and posterior to the submandibular gland. The cyst displaces the sternocleidomastoid muscle posteriorly and the vessels of the carotid space medially.  A subtle curved rim of tissue pointing medially between the internal and external carotid arteries, which is called a “beak sign”. It shows thin mild uniform wall enhancement. 

No stranding of adjacent fatty plans, wall thickening or lymphadenopathy to suggest secondary infection.

Case Discussion

Branchial cleft cysts are the most common congenital neck mass, they appear in early adulthood, usually as painless slow-growing neck swelling as in this patient.

Complications include hemorrhage and secondary infection.

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Case information

rID: 51657
Published: 10th Mar 2017
Last edited: 12th Mar 2017
System: Head & Neck
Inclusion in quiz mode: Excluded

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