A case of third branchial cleft cyst

Abstract

Branchial cyst or congenital cystic lesions of neck originate from branchial clefts, the 2nd branchial cleft cyst being the most common and 3rd and 4th being missed. Hence, they are often misdiagnosed as lymph nodal masses, cold abscess. We are reporting a case of 3rd Branchial cleft cyst, of a 12-year-old boy who presented with left sided recurrent painful cystic mass at the level of hyoid bone going down to the level of pyriform fossa. All the tests for tuberculosis were negative. USG neck revealed loculated thick walled cyst from SCM to lateral part of pharynx. CECT revealed a thick-walled cyst extending from the anterior border of the sternocleidomastoid going down obliquely below the level of thyrohyoid membrane to pyriform fossa. Exploration revealed a thick walled infected cyst, pushing left upper pole of thyroid medially and anterior to left sided superior laryngeal nerve. The cyst was going downwards medially below the level of thyrohyoid membrane. The cyst was excised completely. Histopathology revealed the findings of squamous epithelial lining of cyst wall and cholesterol crystals within. Detailed anatomy on CECT, surgery and histopathology confirmed 3rd arch Branchial cyst.

The Rare Third Branchial Cyst in Paediatric Age Group

“…Third branchial cleft cyst presents as a cyst related to the anterior body of sternocleidomastoid muscle, starting from the level of the hyoid bone can reach up to the pyriform fossa. Because of its relation to the superior laryngeal nerve, it is pushed medially and is anterior to internal carotid artery (6). Differential diagnosis of the lesion may include malignant or benign lymph nodes, malignant or benign neoplasms, inflammatory lymphadenopathy, and bacterial and viral infections.…”

“…Diagnosis can be confirmed by fine-needle aspiration cytology and the presence of a fluid-filled cyst on a CT scan, US, or MRI (5). The initial surgery is crucial since the recurrence rate after incomplete surgical excision can be as high as 22% (6). Our objective was to report a case of 5yr female with third branchial cleft cyst.…”