Second branchial cleft cyst
Painful right neck swelling that increased in size in the past five months. Dyspnea, dysphagia and hoarseness of voice.
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A well-defined right neck cystic lesion mainly at infrahyoid region with a small suprahyoid portion. The lesion measured around 3.4 x 4.1 x 3.4 cm (AP, lateromedial, and cephalocaudal, respectively). It exhibits near-water density with an enhancing wall of non-uniform thickness. Laterally, the lesion is in intimate relation to the sternomastoid muscle, inseparable from its medial wall. Anteriorly, it is indenting the posterior surface of the right submandibular gland. Medially, it is related to the carotid sheath with compression and caliber attenuation of the right internal jugular vein from the level of CV3 through CV6.
Small ipsilateral cervical lymph nodes (levels II, III and V) noted.
The ipsilateral parotid gland is of normal CT features.
The described CT features are of a right neck cystic lesion consistent with infected second branchial cleft cyst type II which is the most common type of this congenital anomaly. Classically, it is located at the anteromedial border of the sternocleidomastoid muscle, lateral to the carotid space, and at the posterior margin of the submandibular gland, related to the angle of the mandible. The location can be anywhere from the pharyngeal wall to the skin along the course of the second branchial apparatus.
FNA gross examination: 30 mL of creamy turbid fluid aspirate.
Microscopic examination: Smears revealed benign lymphoepithelial pyogenic aspirate mainly composed of benign epithelial cysts admixed with few lymphocytes, neutrophils and histiocytes. No malignant cells.