2nd branchial cleft cysts

Thyroglossal
duct pathology and mimics. Thyroglossal duct cyst and branchial cleft cyst. a Axial contrast-enhanced CT image shows a pathology proven thyroglossal duct cyst located anterior to the carotid vessels (arrowheads) and anteromedially to the sternocleidomastoid muscle (asterisks) with a tail-like extension medially to the hyoid bone (arrow). b Axial contrast-enhanced CT image demonstrates a second branchial cleft cyst (star) in a similar location within the right neck without hyoid extension
insightsimaging.springeropen.com • CC-by-4.0
Second
branchial cleft cyst • Infected 2nd branchial cleft cyst and fistula tract from tonsilits - Ganzer Fall bei Radiopaedia
Hsu, C. Infected 2nd branchial cleft cyst and fistula tract from tonsilits. Case study, Radiopaedia.org. (accessed on 21 Oct 2022) https://doi.org/10.53347/rID-26321 • CC by-nc-sa 3.0 (modified)
Second
branchial cleft cyst • Atypical 2nd branchial cleft cyst (type IV) - infected - Ganzer Fall bei Radiopaedia
Niknejad, M. Atypical 2nd branchial cleft cyst (type IV) - infected. Case study, Radiopaedia.org. (accessed on 21 Oct 2022) https://doi.org/10.53347/rID-20986 • CC by-nc-sa 3.0 (modified)
Imaging of
parotid anomalies in infants and children. First branchial-cleft cyst and fistulas. Right isolated intraparotid cyst on axial T2-weighted image (a). Type II anomaly, with an intraparotid cyst and 2 fistulas, the upper fistula running from the cyst to the external auditory canal [white arrow] and the lower running from the cyst to the skin, in Pochet’s triangle [red arrow] (b, c and d). Isolated fistula running from the parotid area to the skin (e). Congenital defect of the floor of the left external auditory canal (tympanal bone) on frontal and axial CT images (f and g)
insightsimaging.springeropen.com • CC-by-4.0
Toddler with
purulent drainage from the right neck. Axial (left) CT with contrast of the neck shows a round, low density mass on the right with rim enhancement anterior to the right sternocleidomastoid muscle and inferior to the angle of the mandible and posterior to the right submandibular gland that has a sinus tract to the skin best seen on the coronal CT (right).The diagnosis was second branchial cleft cyst.
pediatricimaging.org • CC-by-nc-sa 4.0
Branchial
cleft anomalies: a pictorial review of embryological development and spectrum of imaging findings. T1 post-contrast and STIR images demonstrate a T2 hyperintense cystic mass with irregular peripheral enhancement after contrast administration. The abnormality was confirmed to be an infected second branchial cleft cyst in a 54-year-old man who had a history of recurrent infections at the mandibular angle
insightsimaging.springeropen.com • Open Access
Branchial
cleft anomalies: a pictorial review of embryological development and spectrum of imaging findings. Two-year-old child with axial fat-suppressed T1 post-contrast and sagittal short tau inversion recovery (STIR) images demonstrating a rounded and well-defined T1 isointense, T2 hyperintense lesion with thin peripheral enhancement (thick white arrows). It is located posterior to the right submandibular gland (thin white arrow) and anterior to the sternocleidomastoid muscle and carotid sheath (asterisk). This was confirmed to represent a second branchial cleft cyst following surgical excision
insightsimaging.springeropen.com • Open Access
Radiopaedia • CC-by-nc-sa 3.0 • de

Second branchial cleft cysts are a cystic dilatation of the remnant of the second branchial cleft (see branchial apparatus), and along with second branchial fistulae and sinuses accounts for 95% of all branchial cleft anomalies.

Clinical presentation

Although a congenital abnormality, they tend to present in early adulthood (10-40 years of age) often after minor trauma or infection. Second branchial cleft sinus or fistulas, on the other hand, present earlier. Fistulas extend from the skin surface anterior to the middle of the sternocleidomastoid muscle, pass between the internal and external carotid arteries and eventually drain into the tonsillar fossa.

Typically, second branchial cleft cysts present as a rounded swelling just below the angle of mandible, anterior to the sternocleidomastoid (although the position is variable - see classification below).

Pathology

The cyst is typically filled with mucoid material, is well circumscribed and other than presenting as localized swelling, is asymptomatic. However, if infected, surrounding fat stranding and skin changes are evident.

Location

Cysts can occur anywhere along the course of the second branchial apparatus, from the pharyngeal wall to the skin, as it passes laterally and inferiorly between the internal and external carotid arteries. The angle of the mandible is a common location.

Classification

Radiographic features

Ultrasound
  • sharply demarcated
  • posterior acoustic enhancement: 70% 
  • imperceptible walls: 82%
  • echogenicity is variable
    • anechoic: 41%
    • homogeneously hypoechoic with internal debris: 24%
    • pseudo solid: 12%
    • heterogeneous: 23%
CT
  • rounded or spheric, sharply circumscribed
  • fluid density centrally
  • thin wall
  • extension of the cyst wall between the internal and external carotid arteries just above the carotid bifurcation (features sometimes referred to as the notch sign, tail sign or beak sign ), is highly suggestive of the diagnosis but not pathognomonic
MRI
  • T1: variable signal dependent on protein content
    • high protein content: high signal
    • low protein content: low signal
  • T2: usually high signal
  • T1 C+ (Gd): no enhancement in uncomplicated lesions

Treatment and prognosis

Complications
  • superimposed infection

Differential diagnosis

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Zyste oder Fistel des zweiten Kiemenbogens:
Schwannom
 
www.eurorad.org • CC by-nc-sa-4.0
zervikale
bronchogene Zyste
bmcpediatr.biomedcentral.com • CC-by-4.0
Ductus
thyreoglossus Zyste
insightsimaging.springeropen.com • CC-by-4.0
tuberkulöse
Halslymphknoten
insightsimaging.springeropen.com • CC-by-4.0
lymphoepitheliale
Zyste der Glandula parotis
insightsimaging.springeropen.com • CC-by-4.0
Kiemenbogen
 
Wikipedia • CC-BY-SA-3.0
Zyste oder
Fistel des vierten Kiemenbogens
insightsimaging.springeropen.com • Open Access