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Case Fifty Three - Right Second Branchial Cleft Cyst
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Clinical History: Gradually enlarging painless right neck mass.
Findings:
US: Well defined, echogenic mass anterior to the carotid artery, draped anterior to the sternocleidomastoid muscle.
CT: Well defined, low density unilocular mass with a thin uniformly enhancing rim.
Diagnosis: Right second branchial cleft cyst.
Discussion: The differential diagnosis for a well-defined, simple or complex painless neck mass includes:
a .Cystic hygroma, which is most commonly located in the posterior triangle, and most often presents as multiple cysts of varying sizes separated by septae. Rarely they appear as solitary cysts.
b. Branchial cleft cyst, most commonly anterior to the sternocleidomastoid muscle and lateral to the thyroid gland. 90% of branchial abnormalities arise from the second branchial cleft (8% from the first branchial cleft). Of the branchial abnormalities (cysts, sinuses, fistulas), branchial cleft cysts are most common.
c. Dermoid, usually more echogenic than a. or b. Both are located adjacent to or within a thyroid lobe.
d. Hemangioma, capillary hemangiomas appear echogenic, and minimal if any flow is seen on color flow doppler.
e. Neurogenic tumor, the most common primary neoplasm of the neck in childhood. 90% are neuroblastoma, ganglioneuroblastomas or ganglioneuromas; 10% neurofibromas. Paraspinal in location.
f. Lymphoma or rhabdomyosarcoma, both producing enlarged nodes with increased doppler signal.
References:
Siegel, Marilyn J, M.D. Pediatric Sonography, Second Edition. Raven Press, Ltd, New York, 1995.
Latchaw MR and CT Imaging of the Head, Neck and Spine, Second Edition. Vol.2 Mosby, St. Louis, 1991.
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Submitted by:
Anne H. Nicklas, M.D.
Sheila Berlin, M.D.
Rainbow Babies and Children's Hospital
