Figure 1
US of the left submandibular area
Atypical branchial cyst
SectionHead & neck imaging
Case TypeClinical Cases
AuthorsJavier Larrache, María José Pons
Connected authors
15 years, female
Clinical History
A young woman consulted for a 2-month history of a laterocervical painless lump.
The woman was treated with antibiotics without improvement.
Laboratory data were normal.
The woman was treated with antibiotics without improvement.
Laboratory data were normal.
Imaging Findings
US of the left submandibular neck demostrated a uniform, anechoic mass with acoustic shadow, without wall nodules or intra-lesion septae. The mass was avascular on colour-flow ultrasound. The mass was consistent with a cyst.
CT without intravenous contrast showed a well-defined, homogeneous mass, located posterior to the submandibular gland, lateral to the hyoid bone, anterior to the sternocleidomastoid muscle, displacing adjacent structures without infiltration.
There were no other findings like cervical adenopathies. The lesion had a density with attenuation numbers in the range of mature fat, the maximum diameter of the lesion was 38mm.
Post-contrast CT showed no enhancement of the mass.
A local resection was performed. Histological results were consistent with a branchial cyst with giant cell reaction to a foreign body.
CT without intravenous contrast showed a well-defined, homogeneous mass, located posterior to the submandibular gland, lateral to the hyoid bone, anterior to the sternocleidomastoid muscle, displacing adjacent structures without infiltration.
There were no other findings like cervical adenopathies. The lesion had a density with attenuation numbers in the range of mature fat, the maximum diameter of the lesion was 38mm.
Post-contrast CT showed no enhancement of the mass.
A local resection was performed. Histological results were consistent with a branchial cyst with giant cell reaction to a foreign body.
Discussion
Second branchial cysts are the most common of the branchial cleft anomalies accounting for 90 to 95% of cases, and the most common cysts to arise in the neck.
These cysts are lined by stratified squamous columnar epithelium, and occasionally contain hair, skin adnexa and keratin debris.
Clinically they appear as painless fluctuant masses in the lateral portion of the neck adjacent to the anteromedial border of the sternocleidomastoid muscle, and less commonly adjacent to the pharyngeal wall.
There are two hypotheses about their origin: the first one considers this cyst derived from the lateral cervical sinus of His that normally develops during weeks 4 and 5 of embryologic development, the second hypothesis considers the cyst to be derived from trapped epithelial cells within the branchial cleft.
Its location typically is along the anterior border of the sternocleidomastoid muscle and posterior to the submandibular gland.
Its typical sonographic appearance is an anechoic, well-circumscribed lesion with acoustic enhancement; on CT it appears as a well-defined, low-attenuation lesion without contrast enhancement; on MRI these lesion shows prolonged T1 and T2 relaxation times.
If complicated it may contain internal debris or low-level internal echoes and enhance on US or high attenuation on CT. Nevertheless, fatty degeneration is a very uncommon event in branchial cleft cysts.
The differential diagnosis includes other cystic neck masses: external laryngoceles, thyroglossal duct cysts, diving ranulas and lymphangiomas.
On the other hand, fatty masses in the neck are less common and the differential diagnosis includes mainly lipomas and dermoid-epidermoid cysts. Lipomas are benign lesions of mature adipose tissue, 10% involve the neck, usually in obese people, they are fairly more common than its malignant counterpart liposarcoma. The diagnostic clue on CT is a hypodense homogeneous lesion, well-deliniated without capsule or enhancement and fatty content. Epidermal cysts are simple cystic structures lined by squamous epithelium, dermoid cyst are like epidermal ones but also contain skin appendages and connective tissue. Their location is usually in the oral cavity midline or paramedial. Dermoid cysts tend to be fluid on CT and MR and may contain varying amounts of fat.
The definitive treatment for branchial cyst is surgical.
These cysts are lined by stratified squamous columnar epithelium, and occasionally contain hair, skin adnexa and keratin debris.
Clinically they appear as painless fluctuant masses in the lateral portion of the neck adjacent to the anteromedial border of the sternocleidomastoid muscle, and less commonly adjacent to the pharyngeal wall.
There are two hypotheses about their origin: the first one considers this cyst derived from the lateral cervical sinus of His that normally develops during weeks 4 and 5 of embryologic development, the second hypothesis considers the cyst to be derived from trapped epithelial cells within the branchial cleft.
Its location typically is along the anterior border of the sternocleidomastoid muscle and posterior to the submandibular gland.
Its typical sonographic appearance is an anechoic, well-circumscribed lesion with acoustic enhancement; on CT it appears as a well-defined, low-attenuation lesion without contrast enhancement; on MRI these lesion shows prolonged T1 and T2 relaxation times.
If complicated it may contain internal debris or low-level internal echoes and enhance on US or high attenuation on CT. Nevertheless, fatty degeneration is a very uncommon event in branchial cleft cysts.
The differential diagnosis includes other cystic neck masses: external laryngoceles, thyroglossal duct cysts, diving ranulas and lymphangiomas.
On the other hand, fatty masses in the neck are less common and the differential diagnosis includes mainly lipomas and dermoid-epidermoid cysts. Lipomas are benign lesions of mature adipose tissue, 10% involve the neck, usually in obese people, they are fairly more common than its malignant counterpart liposarcoma. The diagnostic clue on CT is a hypodense homogeneous lesion, well-deliniated without capsule or enhancement and fatty content. Epidermal cysts are simple cystic structures lined by squamous epithelium, dermoid cyst are like epidermal ones but also contain skin appendages and connective tissue. Their location is usually in the oral cavity midline or paramedial. Dermoid cysts tend to be fluid on CT and MR and may contain varying amounts of fat.
The definitive treatment for branchial cyst is surgical.
Differential Diagnosis List
Branchial cyst with foreign body reaction
Lipoma
Dermoid cyst
Epidermal cyst
Final Diagnosis
Branchial cyst with foreign body reaction
References
[1] Lev S, Lev Michael (2000) Imaging of cystic lesions. Radiol clin N am vol 38 5: 1013-27 (PMID: 11054966)
[2] Ahuja A,King A,Metreweli C (2000) Second branchial cysts: Variability of sonographic appearances in adult cases. AJNR 21:315-19 (PMID: 10696015)
[3] Woodruff W, Kennedy T (1997) Non-nodal neck masses. Seminars in ultrasound,CT and MRI 18 nº3:182-204 (PMID: 3903851)
Case information
| URL: | https://www.eurorad.org/case/10373 |
| DOI: | 10.1594/EURORAD/CASE.10373 |
| ISSN: | 1563-4086 |
