Unusual location of a second branchial cleft cyst presenting in the suprasternal notch

Abstract

Background: Second branchial cleft cysts (SBCCs) are congenital benign tumors that comprise up to 90% of all branchial cleft anomalies. SBCCs typically present in the lateral neck along the anterior border of the upper third of the sternocleidomastoid muscle. We describe a case of a SBCC presenting in an unusual location in the lower neck close to midline. Methods: An 18-year-old male presented with a 2-year history of a neck mass in the suprasternal notch. Imaging findings were reviewed with a head and neck radiologist who felt that the findings were highly suggestive of a fourth branchial cleft cyst. Results: The patient underwent surgical excision of the mass. Final pathologic evaluation confirmed the diagnosis of a second branchial cleft cyst. Conclusions: Though extremely uncommon, second branchial cleft cysts can extend to the suprasternal notch and should not be excluded from the differential diagnoses of lower neck masses.

Congenital second branchial cleft anomalies in children: A report of 52 surgical cases, with emphasis on characteristic CT findings

“…BCAs are second only to thyroglossal duct cysts (TGDCs) as the most common congenital cervical masses (3,4). Because first, third, and fourth BCAs are rare, congenital second branchial cleft anomalies (CSBCAs) make up 85%-95% of all BCAs (1,2,5). CSBCAs may present as fistulas, cysts, or sinuses, and they usually present with nonspecific symptoms, including discharge from the skin opening, neck swelling, or recurrent infections (6)(7)(8).…”

In Reference to Analysis of the Clinical Features and Surgical Outcomes of First Branchial Cleft Anomalies

“…5 From previous experiences, the nomenclature of FBCAs may often be confusing and misleading, especially in lesions located at the anatomic areas bordering the branchial arches. 6 Hence, a more concise and practical classification of branchial cleft anomalies is warranted. One possible way to do this is applying the novel pathoanatomical-based "BN" classification system.…”