Presentation
Acutely tender left sided neck swelling over 48 hours
Patient Data
Hypodense cystic mass (38 x 33 x 62 mm) anterior and medial to the left sternocleidomastoid muscle, posterior to the slightly inferiorly displaced left submandibular gland, and lateral to the splayed left common carotid artery and internal jugular vein. The mass shows a thickened posteroinferior wall (5 mm) with increased internal density (~26 Hounsfield units) which could represent hyperdense debris layering in dependent portion or thickening of the wall due to acute inflammation; however, there is no fat stranding about the lesion to support this possibility. No internal enhancement, fat stranding or calcification. The pharynx, larynx, thyroid, parotids, sublingual glands and imaged trachea are normal. No cervical lymphadenopathy.
Case Discussion
Differentials diagnoses: second branchial cleft cyst, cervical lymphadenitis/atypical infections (e.g. TB) or neoplasia.
USS + FNA identified no malignant cells. Excision of the mass confirmed a branchial cleft cyst.
Case submitted by Dr Smita Deb and A/Prof Pramit Phal.
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