Branchial cleft anomalies and their mimics: computed tomographic evaluation.

Abstract

A review was made of the clinical records and radiographic examinations of 38 patients with neck lesions clinically suspected of being branchial cleft anomalies. The impact of computed tomography in this sometimes confusing clinical picture was assessed and CT criteria for diagnosing branchial cleft anomalies (BCAs) and differentiating them from their mimics were identified. Seventeen branchial cleft anomalies (four of the first branchial cleft and 13 of the second branchial cleft) and 21 BCA mimics were evaluated. A definitive CT diagnosis of second branchial cleft cysts based on characteristic morphology, location, and displacement of surrounding structures was possible in 80% of cases. CT was found to be the best radiographic examination in making a definitive diagnosis of BCA if a neck mass was present. CT-derived information, by providing additional preoperative data on the extent and type of neck lesion, frequently altered the course of patient management.

Anomalies of branchial cleft: our experience and review of literature

“…2 If there is no communication with the inner mucosa or outer skin, then the trapped branchial arch remnant will form a cyst. 2,7 Choi and Zalzal have reported a maximum incidence of sinuses, followed by fistula. 1,6 In this study, majority of patients presented as discharging sinuses (26/30).…”

“…Amongst these, the widely accepted theory is that branchial anomalies develop as a result of incomplete involution of the branchial apparatus. 1,6,7 Most branchial arch anomalies arise from the second branchial cleft (92.45%). 1,8 Anomalies of first arch remnants (4.72%), third (1.87%) and fourth arch anomalies (0.94%) are quite rare [d].…”

“…On CT imaging, they are well-circumscribed, low-density cystic masses with a thin wall. 2,7 On MRI, T1-weighted imaging may show low to high signal depending on the proteinaceous content of the cyst, but are typically hyperintense on T2-weighted imaging. 2,13 In both CT and MRI imaging, mural thickening and enhancement varies with inflammatory change and typically occurs in the setting of infection.…”

Cysts of the Second Branchial Cleft: Case Report and Surgical Notes

“…The first branchial cleft anomalies are divided into type I cyst within the parotid with a presentation at a young age, type II are present in the front triangle of the neck communicating with the external auditory canal and development in childhood. The second branchial cleft anomalies are divided into: Type I: localized between the platysma and anterolateral surface of the sternocleid omastoid; type II along the anterior surface of the sternocleidomastoid muscle lateral to the carotid space and posterior to the submandibular glands, originating from the space including between the skin and the ipsilateral tonsil; type III are between the internal carotid and the external carotid artery, the presence of a "tail" of the cyst between these two vessels is pathognomonic of type III cysts [10][11][12]. Type IV: originate from the pharyngeal mucosa, deeply compared to the palatine tonsils and often can reach the base of the skull [12].…”

Branchial fistula: review of literature and case report

“…A tissue 'beak' between the internal and external carotid arteries is pathognomonic of Bailey type III cysts. 13 Ultrasound (US): Second branchial cleft cysts are typically well-circumscribed, thin-walled and anechoic with evidence of compressibility and posterior acoustic enhancement. They may contain internal echoes compatible with internal debris.…”