October 11, 2011

Infected Second Branchial Cleft Cyst

Axial CT image of the neck in a 2-year-old boy shows a cystic lesion in the right neck anterior to the sternocleidomastoid muscle, lateral to the carotid space. There is wall enhancement and nearby fascial thickening and subcutaneous fat stranding.

Facts: Branchial Cleft Cyst
  • Type II = most common (92-99% of all branchial cleft cysts)
  • Anywhere along anterior aspect of sternocleidomastoid muscle, lateral to carotid sheath to parapharyngeal space at the level of palatine tonsil
  • CT: fluid density unless infected or hemorrhagic
  • MRI: T1 hypointense, T2 hyperintense (unless infected or hemorrhagic)
  • Can be associated with fistula or sinus tract
Other Things To Consider: Necrotic lymph node/metastasis, dermoid, abscess, laryngocele, ectopic thymic cyst

What Surgeons Want To Know
  • Infection? May need surgery if at risk of septicemia or abscess
  • Mass effects? Compression of esophagus, airways
  • Neoplasm?
  • Treatment of infected branchial cleft cyst is different from simple abscess. In the former, I&D alone is not adequate but the entire cyst and its tract must be removed to prevent recurrence. Therefore, it is important that accurate diagnosis is made preoperatively.
Our case: infected second branchial cleft cyst

1. Bailey BJ, Calhoun KH. Atlas of Head & Neck Surgery-Otolaryngology, 2001.
2. Lin EC, Escott EJ, et al. Practical Differential Diagnosis for CT and MRI, 2008.

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