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Diagnosis
Branchial Cleft Cyst Type II

Case 2

                                                                                Contributors

                                                     Dr. Ambika Gayad, Dr. Kiran

  Radiological Findings, Disease course and Management

 

  High Resolution Ultrasound of Neck

 

 

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  Findings

  • An oblong  5 x 3.5 cm large hypoechoic lesion with fine internal echoes seen on the right side of the neck,just below the angle of mandible,deep to middle thirds of the sternocleidomastoid muscle.

  • Lesion has thin imperceptible walls with posterior acoustic enhancement

  • Thin internal septation near the lower pole of the lesion.

  • No internal vascularity on color doppler study

  • Normal surrounding soft tissues 

  • No regional lymphadenopathy

 

  Provisional Diagnosis

    Cystic lesion on the right side of neck , just below the angle of               mandible deep to sternocleidomastoid, most likely a branchial cleft cyst

 

  MRI Neck (without contrast)

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                                          T2W

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                         

                                         STIR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

  Findings

  • Solitary ,well defined, 5 x 3.6 x 2.5 cm cystic lesion on the right side of the neck,located just below the angle of the mandible posterolateral to submandibular gland, lateral to the carotid space and anteromedial to the sternocleidomastoid muscle

  • Hyperintense on T2W and STIR images with intermediate signal intensity on T1W images

  • Thin T2W hypointense internal septations within the lesion near its lower pole

  • Lesion displaces the common carotid artery and  internal jugular vein medially. Flow voids appear normal

  Course 

  • Excision biopsy of the lesion and a regional lymph node done

  • Histopathology: Branchial cleft cyst

                     Lymph node- reactive

  • Patient is asymptomatic presently and has been advised regular follow up

  Discussion

  95% of branchial cleft anomalies arise from second cleft

  Range of anomalies

  • Cysts- no internal or external communication

  • Fistula-has internal and external communication

  • Sinus- incomplete tract

  Most common: Cyst

  Aetiology:Cystic dilatation of the second branchial cleft remnant

  Age : 10-40 years often after minor trauma or infection 

   

  Bailey Classification Of Cysts

  • Type I -    most superficial

                        lies along the anterior surface of sternocleidomastoid muscle

                 just deep to the platysma muscle

  • Type II  - Most common

                 Classic location:along anterior surface of the

                 sternocleidomastoid muscle,lateral to the carotid space

                 posterior to the submandibular gland

  • Type III - Extends medially between the bifurcation of the internal and                external carotid arteries to the lateral pharyngeal wall.

  • Type IV  - Lies in the pharyngeal mucosal space

 

  Radiologic Features

  Ultrasound

  • Sharply marginated, round to ovoid,centrally anechoic mass

  • Thin peripheral wall displacing surrounding soft tissues

  • Distinct acoustic enhancement

  • At times,fine,indistinct internal echoes s/o debris,may be seen.

  CT

  • Cysts well-circumscribed,homogeneously hypoattenuated

  • Surrounded by a uniformly thin wall                 

  MR imaging

  • Better depicts the deep tissue extent

  • Allows accurate preoperative planning 

  • T1W- Cyst fluid varies from hypointense to slightly hyperintense relative          to muscle

  • T2W-Usually hyperintense

  • Mural thickness and enhancement vary, depending on presence and severity of associated inflammatory process 

  • “Beak sign” may be seen on axial CT/ MR images 

     represents curved rim of tissue pointing medially between internal and          external carotid arteries.

     Pathognomonic imaging feature of a second branchial cleft cyst,                  specifically a Bailey type III cyst 

 

  References

 

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