A tale of two anomalies: fourth branchial cleft cyst with thyroid hemiagenesis

Sonographic diagnosis of coexisting ectopic thyroid and fourth branchial cleft cyst

“…In this case, a fourth branchial cleft sinus and an ectopic lingual thyroid gland were found together in the same patient. To the best of the knowledge of the researchers, this is the first report presenting these two rare congenital anomalies simultaneously, except for a similar case which reported a fourth branchial cleft cyst with thyroid hemiagenesis …”

“…To the best of the knowledge of the researchers, this is the first report presenting these two rare congenital anomalies simultaneously, except for a similar case which reported a fourth branchial cleft cyst with thyroid hemiagenesis. 8 Fourth branchial cleft anomalies are commonly left sided and most often present as a sinus tract, coursing from the apex of the pyriform fossa to the upper aspect of the left thyroid lobe. 3 The opening of the fourth branchial cleft remnant at the pyriform sinus plays a role in spreading infection from the pharynx to the remnant branchial anomaly.…”

Prenatal tomography ultrasound imaging diagnosis of fetal pyriform sinus cysts (third or fourth branchial cleft cyst): A case report

“…The pyriform sinus is a crucial anatomical structure of the pharynx and larynx, which comprises symmetrical aryepiglottic folds and lateral pharyngeal walls on both sides. PSCs are rare branchial anomalies that occur in the pyriform sinus, and are also known as third or fourth branchial cleft cysts 1–3 . Histologically, distinguishing between the origin of the third or fourth branchial arch relies mainly on its relationship with the recurrent laryngeal nerve; however, this distinction cannot be made through imaging techniques, 4 leading to their collective reference as PSCs.…”

“…PSCs are rare branchial anomalies that occur in the pyriform sinus, and are also known as third or fourth branchial cleft cysts. [1][2][3] Histologically, distinguishing between the origin of the third or fourth branchial arch relies mainly on its relationship with the recurrent laryngeal nerve; however, this distinction cannot be made through imaging techniques, 4 The cyst cavities associated with third and fourth branchial cleft anomalies are located within the piriform sinus and are hence called piriform sinus cysts. [5][6][7] This disease usually occurs in infants and children, but it is very rare for it to occur during the fetal period.…”

Hemiagenesis of the thyroid gland detected by coincidence—what is the clinical relevance?

“…Ectopic sublingual thyroid gland [ 5 – 7 ] and thyroglossal duct cysts [ 8 ] have been reported in combination with THA as well. Pathologies of the parathyroid gland or other pathologies within the neck region with growing masses can also lead to a thyroid investigation and detection of THA [ 9 – 11 ]. Thus, THA is detected in most reported cases only by coincidence, and the majority of cases with THA therefore likely remain undetected, as THA by itself frequently causes no clinical symptoms.…”