Fourth Branchial Cyst Presenting with Neonatal Respiratory Distress

Abstract

Fourth branchial cysts are quite rare. A neonate with a left lateral neck mass and respiratory distress was found to have a fourth branchial cyst, which was diagnosed with computed tomography and endoscopy. The characteristic computed tomography findings included an air-containing neck cyst, which was located at the anteromedial site of the common carotid artery with mediastinal extension. Endoscopic examination revealed an internal opening at the apex of the pyriform sinus, communicating with the cyst. Total excision of the cyst was performed, and the specimen, which showed ciliated columnar epithelium with a subepithelial lymphoid infiltrate, thyroid follicles, and thymic tissue, histologically confirmed the diagnosis.

Neonatal vs Delayed-Onset Fourth Branchial Pouch Anomalies

“…3,4,[6][7][8]18 In our experience, histologic examination of the resected specimen shows the presence of malpighian epithelium lining the tract along its path as well as the pouch, as described in the literature. 6,7,18 This contrasts with the histologic findings of cases presenting later in childhood in which such epithelium lining is restricted to the tract itself. [12][13][14] Five of our patients were in this neonatal category.…”

Management of anomalies of the third and fourth branchial pouches

“…CT scanning is the investigation of choice for displaying both location and extent of piriform sinus anomalies [21]. Obtaining a CT scan immediately after barium swallow may increase the sensitivity of the scan by highlighting the sinus tract.…”

Neonatal Presentation of an Air-Filled Neck Mass that Enlarges with Valsalva: A Case Report

“… 10 11 Although rare, neonatal presentations of third branchial cleft cysts have been reported in the literature. 2 3 6 8 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 The presentation of both third and fourth branchial cleft cysts typically begins with left-sided acute lateral neck swelling, pain, and fever, findings suspicious for either neck abscess or acute suppurative thyroiditis with or without upper respiratory tract infection. Atypical presentations with respiratory distress or with a cutaneous discharging fistula have also been reported, and respiratory distress is more likely for those in the neonatal period.…”