Branchial fistula: an imaging perspective

Abstract

DISCUSSIONThe branchial apparatus were first described by Von Baer while its anomalies were first described by von Ascheroni.3 The branchial fistula is an uncommon anomaly of embryonic development of branchial apparatus. Amongst these, anomalies of second branchial arch as well as pouch are common. They represent 90-95% of branchial anomalies. 4 During embryonic development, the second arch grows caudally and it covers the second, third, and fourth branchial clefts. The cervical sinus of His is formed by the fusion of this second arch with the enlarging epipericardial ridge of the fifth arch. The edges of cervical sinus in the due course fuse and hence in life no defect is seen. However, it is the persistence of intervening ectoderm that gives rise to branchial cyst. The branchial fistula results from breakdown of the endoderm, usually in the second pouch. In the normal course a persistent fistula of the second branchial cleft and

Lateral cervical sinus: specific sonographic findings in two pediatric cases

“…This was a limitation for sonography. In those situations, CT, MRI, and contrast fistulograms provide better evaluations than sonography [8,10]. In both of our cases, the cranial side of the tracts could be evaluated by contrast fistulograms, not by sonography.…”

“…Unless infection or hemorrhage has occurred, CT shows fluid density within the cyst or fistula [9,10]. A CT fistulogram is useful for obtaining images delineating the relation of the sinus tract to the important structures of the neck [10].…”

“…A CT fistulogram is useful for obtaining images delineating the relation of the sinus tract to the important structures of the neck [10]. MRI shows cyst and fistula with low signal intensities on T1-weighted images and high signal ones on T2-weighted images, respectively, unless they are infected or hemorrhagic [9].…”

Selective Neck Dissection: A Novel Technique for Second Branchial Arch Anomalies

“…10 Imaging modalities include computed tomography (CT) scan, magnetic resonance imaging (MRI), fistulogram and ultrasonography (USG) of neck. Role of USG neck is limited as it fails to evaluate the extent and depth of lesions particularly the fistulae.…”

“…15 Complete surgical excision is the only definitive treatment. 3,10,12,14 Incomplete removal results in recurrent infections and distortion of surgical planes. 12 Cannulating the tract with monofilament suture or probe can also create false passage.…”