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LETTER TO EDITOR
Year : 2018  |  Volume : 4  |  Issue : 1  |  Page : 71-72

Imaging features of branchial cleft cyst


1 Department of Radiology, St. John's Medical College, Bengaluru, Karnataka, India
2 Department of Critical Care Medicine, St. John's Medical College, Bengaluru, Karnataka, India

Date of Web Publication25-May-2018

Correspondence Address:
Reddy Ravikanth
Department of Radiology, St. John's Medical College, Bengaluru - 560 034, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrsm.jcrsm_62_17

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How to cite this article:
Ravikanth R, Pinto DS, Fernandes RA. Imaging features of branchial cleft cyst. J Curr Res Sci Med 2018;4:71-2

How to cite this URL:
Ravikanth R, Pinto DS, Fernandes RA. Imaging features of branchial cleft cyst. J Curr Res Sci Med [serial online] 2018 [cited 2018 Sep 23];4:71-2. Available from: http://www.jcrsmed.org/text.asp?2018/4/1/71/233200



Dear Sir,

A 17-year-old man presented with a history of swelling in the left side of the neck, which gradually increased in size over the past 3 years. It was associated with recurrent episodes of infection, for which he underwent surgical and medical management. A well-defined swelling was noted deep to the left sternocleidomastoid muscle and was associated with significant lymphadenopathy. Contrast-enhanced computed tomography (CECT) of the neck was performed as part of the imaging workup to assess the size and extent of the lesion. CECT of the neck revealed a well-defined uniformly hypodense cystic lesion with thin walls causing posteromedial displacement of the left sternocleidomastoid muscle [Figure 1] and the vessels of the carotid space [Figure 2] with anterior displacement of the left submandibular gland [Figure 3]. Enlarged upper jugular (level II) cervical lymphadenopathy was present on the left. A provisional diagnosis of the second branchial cyst was made. Fine-needle aspiration cytology was done for pathological confirmation of the branchial cyst, and surgical excision was performed which resulted in evasion of patients symptoms.
Figure 1: Axial contrast-enhanced computed tomography neck image at the level of thyroid cartilage showing well-defined cystic lesion (straight arrow) deep to the left sternocleidomastoid muscle (curved arrow) in the left carotid space

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Figure 2: Coronal reformatted contrast enhanced computed tomography neck image showing a left-sided second brachial cleft cyst (arrow) extending from the level of the bifurcation of the common carotid artery to the level of the thyroid cartilage

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Figure 3: Sagittal reformatted contrast-enhanced computed tomography neck image showing second branchial cleft cyst (arrow) in the carotid space at the angle of the mandible

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Branchial cleft cysts are benign lesions caused by defective involution of the branchial cleft. The first branchial cleft develops into the external auditory canal. The second, third, and fourth branchial clefts merge to form the sinus of his, which will normally become involuted. When Sinus of His is not properly involuted, a branchial cleft cyst forms. Second branchial cleft cysts are cystic dilatations of the remnant of the 2nd branchial apparatus, and along with 2nd branchial fistulae and sinuses accounts for 95% of all branchial cleft anomalies.[1] Second branchial cleft cysts present clinically as a soft-tissue swelling in the anterior neck. Although the roles of CT and magnetic resonance imaging are well documented, the superficial location of the lesions in the anterior neck makes them accessible to sonographic evaluation. Preoperative diagnosis is based on the clinical and radiological findings for the assessment of spatial characteristics of the lesion with precision. Ultrasonography is the first line imaging method of choice for defining the benign, cystic nature of the lesion.[2] On CT, these cysts appear as typically well-circumscribed, hypoattenuated masses surrounded by a uniformly thin wall.[3] The presence of an inflammatory process is often reflected by thickening and increased enhancement of the walls, which resembles an abscess or lymphadenopathy. Intracystic hemorrhage is usually caused by secondary infection or biopsy attempts. Hemorrhages appear hyperdense on CT.[4] Vast majority (90%) of branchial malformations arise from the second cleft. Although these masses are present since birth, they are usually identified in the second to fourth decades of life, when they become enlarged secondary to infection or rupture. Second branchial cleft cysts appear at the angle of the mandible and may involve the submandibular gland. A second branchial cleft cyst is one of the differential diagnoses for parapharyngeal mass. Although percutaneous ablation can be considered for branchial cleft cysts, surgery remains the treatment of choice.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Acierno SP, Waldhausen JH. Congenital cervical cysts, sinuses and fistulae. Otolaryngol Clin North Am 2007;40:161-76, vii-viii.  Back to cited text no. 1
    
2.
Guldfred LA, Philipsen BB, Siim C. Branchial cleft anomalies: Accuracy of pre-operative diagnosis, clinical presentation and management. J Laryngol Otol 2012;126:598-604.  Back to cited text no. 2
    
3.
Som P. Cystic lesions of the neck. Postgrad Radiol 1987;7:211-36.  Back to cited text no. 3
    
4.
Ghosh SK, Kr T, Datta S, Banka A. Parapharyngeal second branchial cyst: A case report. Indian J Otolaryngol Head Neck Surg 2006;58:283-4.  Back to cited text no. 4
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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