Constitutional symptoms are the most common clinical manifestation of the systemic disease. When there is the presence of cervical lymphadenopathy concurrently, systemic infection or malignancy has to be taken into consideration. At the paediatric or adolescent age group, tuberculosis and lymphoma are the common diseases that associated with these symptoms. We should consider patient’s age group, risk factors and the disease presentation for the diagnosis. With the guidance of the imaging studies, laboratory and histopathological studies, the precise final diagnosis is made. Bangladesh Journal of Medical Science Vol.18(1) 2019 p.149-152

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Branchial anomalies are congenital lesions that occur as a result of incomplete obliteration of the branchial apparatus during foetal development. Due to their complex presentations, they are commonly misdiagnosed and pose a challenge in treatment. This report features a girl, aged 1 year and 2 months, with Goldenhar syndrome with right microtia, presenting with a rare supra-auricular fistulous opening to the external auditory canal, with a communicating tract in the neck.