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Radiol Clin North Am 2020 May;58(3):639-652

Division of Thoracic Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 20115, USA. Electronic address:

Congenital entities sharing imaging characteristics with true pathologies occasionally are discovered incidentally in adults. These may occur in the neck, chest, abdomen/pelvis, or musculoskeletal systems. Although these incidental findings share imaging features with true pathologic processes, up-to-date knowledge and assessment with the most appropriate imaging modalities generally allow a distinction between congenital entities that may be safely dismissed and pathologic processes requiring further assessment and treatment. Read More

Clin Imaging 2020 Aug 15;64:1-6. Epub 2020 Feb 15.

Department of Radiology, Baylor College of Medicine, Houston, TX, USA.

Branchial cleft cysts are the most common lesions in the lateral neck with ectopic thyroid tissue found only rarely within these cysts. Over the years, multiple cases of papillary thyroid carcinoma arising from these ectopic thyroid tissues have been described in the literature with these cases sharing a normal thyroid gland on surgical and histological evaluation. Recently, however, there are three cases of papillary thyroid carcinoma in a branchial cleft cyst reported to be the result of metastasis from a thyroid primary. Read More

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020 Feb;34(2):146-149

Department of Radiology and Medicine Imaging，Shanghai Children's Hospital，Children's Hospital Affiliated to Shanghai Jiaotong University，Shanghai，200040，China.

The aim of this study is to evaluate the value of multi-slice spiral CT （CT） and multi-planar reconstruction （MPR） in the diagnosis of children with parotid cleft deformity. The CT images of 55 cases of branchial cleft deformity confirmed by surgery and pathology were retrospectively analyzed. CT examination showed that 37 cases had strip-like, tubular fistula or cystic mass located in the anterior cervical triangle, anterior margin of sternocleidomastoid muscle, and 2 of them had bilateral fistula structure. Read More

AACE Clin Case Rep 2019 Nov-Dec;5(6):e365-e368. Epub 2019 Aug 14.

Objective: Acute suppurative thyroiditis (AST) is frequently caused by anatomic abnormalities, including branchial cleft cysts. Patients with AST are typically euthyroid, but thyrotoxicosis may occur. Thyroid antibodies are usually not present in AST. Read More

Otolaryngol Head Neck Surg 2019 11 2;161(5):904-905. Epub 2019 Jul 2.

Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

J Craniofac Surg 2019 Jun;30(4):e295-e297

Department of Pathology, Ataturk University, Erzurum, Turkey.

Cervical thymic cyst is rare lesions leading to cervical mass. As it is a rare entity, it might be confused with other congenital neck masses or neoplastic lesions. Preoperative diagnosis is almost impossible. Read More

Tunis Med 2018 Dec;96(12):888-892

Background: the amygdaloid cyst is a rare laterocervical cystic tumor arising from the second branchial cleft. It accounts for 2% of laterocervical tumors.

Aim: analyze the anatomo-clinical characteristics and discuss the management and therapeutic indications of second branchial cleft cysts. Read More

J Craniofac Surg 2019 Sep;30(6):1772-1773

Department of Ear Nose and Throat, MedCare Hospital, Dubai, United Arab Emirates.

Second branchial cleft cysts (BCCs) are the most common type of branchial abnormalities and usually found high in the neck. Oropharyngeal presence of a BCC is very rare. The authors report a rare case of oropharyngeal, second branchial, multilocular, cleft cyst in a 9-year-old child (8. Read More

Ear Nose Throat J 2019 Jun 8;98(5):295-298. Epub 2019 Apr 8.

1 Department of Otolaryngology-HNS, Research Institute for Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, Korea.

Clinically, it may be very difficult to differentiate between benign branchial cleft cyst (BCC) and malignant BCC with papillary carcinoma preoperatively. Radiological features were reviewed retrospectively between benign BCC and malignant BCC with papillary carcinoma using computed tomography (CT) and magnetic resonance (MR) images. All patients had only a mass on the right upper lateral neck without lesion in the thyroid gland. Read More

Pol J Radiol 2018 11;83:e204-e209. Epub 2018 May 11.

Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India.

Cystic masses of the neck may represent a wide variety of pathological conditions. Among these, branchial anomalies are the commonest paediatric congenital lesions of the head and neck. This article intends to review this condition under the same headings, as well as facilitate their diagnosis with the help of appropriate radiological findings of patients diagnosed with these anomalies. Read More

Int J Oral Maxillofac Surg 2019 Jun 20;48(6):712-715. Epub 2018 Dec 20.

Department of Stomatology, Peking Union Medical College Hospital, Beijing, China. Electronic address:

Branchial cleft cysts (BCC) are benign lesions caused by anomalous development of the branchial apparatus. This case report describes a 63-year-old woman with a 12 cm×12cm sized cystic mass located anterior to the manubrium sternum and sternum. MRI revealed a cystic lesion with a sinus tracking to the piriform sinus. Read More

Klin Onkol Summer 2018;31(4):296-300

Background: Primary branchiogenic carcinoma (BC) is an exceptional diagnostic entity. In most cases, suspicion of BC is confirmed to be a cystic lymph node metastasis of an occult primary tumor. Martin and Khafif therefore established diagnostic criteria, emphasizing above all the importance of a histologically assessed transformation of cystic lining epithelium into an invasive squamous cell carcinoma in one pathological lesion after the exclusion of a primary tumor. Read More

Radiol Med 2019 Mar 12;124(3):199-205. Epub 2018 Nov 12.

Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.

Purpose: The present study aimed to assess CT and MR imaging findings of infection-free and benign second branchial cleft cysts (SBCCs).

Methods: Eleven patients with histopathologically confirmed infection-free and benign SBCCs underwent preoperative contrast-enhanced CT (CECT) and/or MR imaging. We assessed qualitative (presence and extent of wall thickening, degree of contrast enhancement of the thickened wall on CECT images, and signal intensity of the thickened wall on T2-weighted images) and quantitative (maximum thickness of the thickened wall) imaging findings. Read More

Clin Perinatol 2018 12 18;45(4):769-785. Epub 2018 Sep 18.

Department of General Surgery, Greenville Health System, Greenville ENT Associates, 200 Patewood Drive Suite B400, Greenville, SC 29615, USA.

Congenital neck masses can be a developmental anomaly of cystic, solid, or vascular origin. They can also constitute neoplasms, including malignancies, although this is rare in the pediatric population. The history and examination can help quickly narrow the differential diagnosis. Read More

Presse Med 2019 Jan 1;48(1 Pt 1):29-33. Epub 2018 Nov 1.

Hôpital d'instruction des Armées-Percy, service d'ORL et de chirurgie cervico-faciale, 101, avenue Henri-Barbusse, 92140 Clamart, France.

Cervical congenital malformations are relatively common in children. They can also be found in adults. The embryological development of the cervical region is closely related to the branchial clefts. Read More

J Clin Ultrasound 2018 Nov 4;46(9):582-584. Epub 2018 Oct 4.

Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, South Korea.

Ectopic thyroid and fourth branchial cleft anomaly are rare congenital anomalies of the neck. This is a case report of the coexistence of these two rare congenital anomalies in a 1-year-old girl. She had ectopic lingual thyroid and asymptomatic abscess in the fourth branchial cleft cyst, which was found in ultrasonography carried out to evaluate congenital hypothyroidism. Read More

BMJ Case Rep 2018 Aug 9;2018. Epub 2018 Aug 9.

Medical Imaging Research Center, Radiology Department, Shiraz University of Medical Sciences, Shiraz, Iran.

Here we report a rare case of primary hydatid cyst with involvement of soft tissue of the neck in a child. A 4-year-old girl presented with gradual swelling of the right side of her neck over a period of several months. The lump was fairly soft and painless with no significant inflammation. Read More

Case Rep Otolaryngol 2018 21;2018:1696875. Epub 2018 Jun 21.

Department of Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.

Pyriform sinus fistula (PSF) is an anomaly that can arise due to failure of involution of the third or fourth branchial cleft during embryogenesis. It can manifest clinically as sinuses, cysts, or abscesses in the neck and is common in childhood. Herein, we describe a neonate who presented with neck swelling and respiratory distress, which was secondary to a fourth branchial pouch sinus. Read More

Radiographics 2018 Jul-Aug;38(4):1239-1263

From the Department of Radiology, Kravis Children's Hospital at the Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY 10029.

Superficial palpable masses of the head and neck are common in the pediatric population, with the vast majority of the lesions ultimately proven to be benign. Duplex ultrasonography (US) has emerged as the first-line imaging modality for the evaluation of superficial pediatric masses. Without utilizing radiation, iodinated contrast material, or sedation and/or anesthesia, US provides a means for quick and cost-effective acquisition of information, including the location, size, shape, internal content, and vascularity of the mass. Read More

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2017 Aug;31(16):1298-1299

We describe a case of a 55-year-old man who presented with sore throat for two days, while neck swelling for one day, and was found to have a fistula in his left tonsil and an abscess in his left lateral pharyngeal wall with the lower bound to the upper border of the cricoid cartilage by ultrasonography and enhanced CT. The fistula from tonsillar fossa to hypopharynx was detected followed by left tonsillectomy, and then anterior wall of the fistula and mucosa covering it was resected. He was eventually diagnosed with incomplete second branchial fistula with infection, and was followed up for five years with no recurrence. Read More

J Stomatol Oral Maxillofac Surg 2018 Nov 19;119(5):440-443. Epub 2018 Apr 19.

ENT department, Farhat Hached University Hospital, Sousse, Tunisia.

Introduction: Malignant degeneration of a branchial cyst is rare (Thompson, 1997). It varies from 4% to 22% (Unal et al., 2005). Read More

Int J Surg Case Rep 2017 16;41:383-386. Epub 2017 Nov 16.

Maxillo-Facial Surgery Unit, ASST Spedali Civili, Brescia, Italy.

Introduction: Branchial cleft cysts are benign lesions caused by anomalous development of the branchial cleft. Cases that arise in the lateral neck region are often misdiagnosed, resulting initially in inappropriate management.

Case Presentation: We describe a 32-year-old woman with a swelling on the right side of her neck and no pain during palpation or neck motion. Read More

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018 Feb;53(2):81-85

Department of Otorhinolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijng 100050, China.

To summarize the clinical characteristics and therapeutic experiences of the middle ear teratoma in infants. Three cases of middle ear teratoma, from 2012-2015 in Beijing Friendship Hospital were analyzed. The three cases all developed slowly and presented unilateral otorrhea and hearing loss. Read More

Biomed Res Int 2017 19;2017:1807056. Epub 2017 Dec 19.

Institute of Pathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

Background: Even though branchial cleft cysts are currently accepted as a congenital anomaly, there is often a long delay until clinical presentation; branchial cleft cysts classically appear in the second to fourth decade of life. Our observation of their occurrence in three pregnant women encouraged us to contemplate a possible hormonal influence.

Methods: Immunohistological analysis was performed for the evaluation of the estrogen receptor alpha (ER) in paraffin-embedded tissue specimens of 16 patients with a diagnosis of branchial cleft cyst, with three of them being pregnant. Read More

BMC Oral Health 2017 Nov 28;17(1):139. Epub 2017 Nov 28.

Department of Otorhinolaryngology Head and Neck Surgery, The China-Japan Union Hospital of Jilin University, Xiantai Street 126, Changchun, 130033, China.

Background: A cervical cystic mass is associated with a number of pathologies that present with similar symptoms. These conditions are difficult to differentiate using fine-needle aspiration (FNA), ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). Another dilemma in the differential diagnosis of cervical cystic masses is due to the controversies associated with the existence of branchiogenic carcinoma (BC). Read More

J Int Adv Otol 2017 Dec 2;13(3):419-421. Epub 2017 Nov 2.

Eye and Ear Nose and Throat Hospital Fudan University, Department of Otology and Skull Base Surgery, Shanghai, China.

The goal of this case report is to describe an unusual case of recurrent first branchial cleft fistula with cysts and the effective surgical approach of complete removal with preservation of the facial nerve. A 27-year-old woman presented to our clinic after unsuccessful removal twice during the last 20 years. We have achieved satisfactory outcomes by using an approach to identify the facial nerve at the stylomastoid foramen with canal wall up mastoidectomy under a microscope. Read More

Laryngoscope 2018 04 3;128(4):998-1001. Epub 2017 Aug 3.

Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.

A 15-year-old boy was diagnosed with a cystic parotid mass, which was initially thought to be a first branchial cleft cyst. The mass was treated with antibiotics and fully resolved on examination and imaging. The mass returned, and a superficial parotidectomy was performed to remove the suspected branchial cleft cyst. Read More

Auris Nasus Larynx 2018 Apr 14;45(2):328-331. Epub 2017 Apr 14.

Department of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Tao-Yuan, Taiwan; College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan. Electronic address:

Objective: Cancers found in the resected branchial cleft cyst are rare clinically but usually impose substantive diagnostic and treatment challenges for clinicians.

Methods: A 31-year-old man presented with a lateral neck mass that was suspected to be an inflammatory branchial cleft cyst. After excision, the pathologic specimen revealed a benign cystic appearance with a focus of undifferentiated carcinoma. Read More

Eur Ann Otorhinolaryngol Head Neck Dis 2017 09 5;134(4):281-282. Epub 2017 Apr 5.

Clinique universitaire d'ORL et chirurgie cervico-faciale, hôpital Nord-Michallon, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 9, France; Faculté de médecine, universités des Alpes, Domaine de la Merci, 38700 La Tronche, France; UGA/UMR/CNRS 5309/Inserm 1209, institut Albert-Bonniot, Rond-Point de la Chantourne, 38706 La Tronche, France.

N Engl J Med 2016 Oct;375(16):e33

Children's Hospital at Montefiore, Bronx, NY.

Ethiop Med J 2016 Jul;54(3):145-7

Cysts commonly occurring in the neck include thyroglossal cyst and dermoid cysts in the midline, cystic thyroid nodules, branchial cysts and cystic Hygroma in the lateral neck. Hydatid cyst disease is commonly seen in the right lobe of the liver, the lung and rarely in other parts of the body. In general, cysts in the neck are not common in the second decade of life. Read More

ANZ J Surg 2018 09 19;88(9):E677-E678. Epub 2016 May 19.

ENT Unit, Department of Surgery, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia.

Nihon Jibiinkoka Gakkai Kaiho 2016 Feb;119(2):118-24

In recent years, human papillomavirus (HPV)-positive oropharyngeal carcinomas have been increasing. The first manifestation of these tumors is frequently as cystic metastasis to cervical lymph nodes that may precede recognition of the primary tumor, so, they often result in misdiagnosis as branchial cleft cysts. We report a case of cystic cervical lymph node metastasis of HPV-positive tonsil cancer. Read More

Ear Nose Throat J 2016 Apr-May;95(4-5):154-6

Department of Surgery, The Pennsylvania University College of Medicine, Hershey, PA, USA.

Proc (Bayl Univ Med Cent) 2016 Apr;29(2):183-4

Texas Tech University Health Sciences Center School of Medicine (Schmidt); and the Departments of Surgery (Leal, McGill) and Radiology (Jacob), Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas.

Up to 20% of all congenital pediatric head and neck masses are branchial cleft cysts. Second branchial cleft cysts account for 95% of branchial anomalies, and fourth branchial cleft cysts are the rarest type. Their typical presentations include non-life-threatening symptoms, such as drainage, skin irritations, minor swelling, and tenderness. Read More

Fogorv Sz 2015 Dec;108(4):127-30

Branchiogen anomalies represent a heterogeneous group of developmental abnormalities, they arise from incomplete obliteration of branchial clefts and pouches during embriogenesis. Clinically they can present as a cyst, fistula or sinus. Second cleft lesions account for 95% of the branchial anomalies. Read More

B-ENT 2016;12(4):291-296

Assessment and management of presumed branchial cleft cysts: our experience.

Objectives: The aim was to assess the accuracy of diagnosis and management of presumed branchial cleft cysts in our centre.

Methodology: Retrospective review of patients with a clinical diagnosis of branchial cleft cyst at B arts Health NHS Trust from 2009 to 2015. Read More

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015 Aug;29(15):1392-3

The patient complained of finding on the right side of the neck fistula with discharge nine years. In recently, fistula spills significantly increased compared with the previous. Special physical examination: Right sternocleidomastoid middle 1/3 front border is seen here in a small fistula, translucence jelly secretion were spilling out when squeezeing the fistula, no smell. Read More

Insights Imaging 2016 Feb 10;7(1):69-76. Epub 2015 Dec 10.

Department of Radiology, Royal London Hospital, Barts Health NHS Trust, London, UK.

Unlabelled: The branchial arches are the embryological precursors of the face, neck and pharynx. Anomalies of the branchial arches are the second most common congenital lesions of the head and neck in children, with second branchial arch anomalies by far the most common. Clinically, these congenital anomalies may present as cysts, sinus tracts, fistulae or cartilaginous remnants with typical clinical and radiological findings. Read More

Medicine (Baltimore) 2015 Oct;94(42):e1758

From the Department of Pathology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan.

Branchial cleft cysts (BCCs) are also named lateral cervical cysts and widely acknowledged as being derived from embryonic remnants. Lymphoepithelial cysts (LECs) generally show microscopic features that are identical to those of BCCs, and rarely occur at unusual sites or organs.A case of multiple cysts arising in both lobes of the thyroid gland, thymus, and right parotid gland in a 41-year-old man is reported. Read More

J Med Case Rep 2015 Sep 29;9:208. Epub 2015 Sep 29.

Department of Cardiothoracic Surgery, Kenyatta National Hospital, Hospital Road, Nairobi, 00202, Kenya.

Introduction: Complex embryological processes form the head and neck of humans. It is not flawless; remnants lead to sinuses or cysts, commonly in the head and neck region.

Case Presentation: We present the a case of an 8-year-old boy, a primary school pupil, from rural Kenya with chronic cough, wheezing, difficulty in breathing and dyspnea on exertion. Read More

J Pediatr Health Care 2016 Mar-Apr;30(2):155-9. Epub 2015 Aug 17.

Cleft Palate Craniofac J 2017 03 8;54(2):223-226. Epub 2015 Jul 8.

Objective: Cervical chondrocutaneous branchial remnants are rare malformations usually found in the lower neck. As high as 76% of patients have been reported to have associated anomalies. We review the literature and report a case series of seven patients with cervical cartilaginous remnants. Read More

J Neuroradiol 2015 Jun 6;42(3):156-61. Epub 2015 Apr 6.

Department of Neuroradiology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; FMRIB Centre, Department of Clinical Neurology, University of Oxford, Oxford, UK.

Background And Purpose: Cavum-trigeminale-cephaloceles (CTCs) are rare lesions of Meckel's cave and the petrous apex. Despite distinctive imaging features, they are frequently mistaken for other petrous apex lesions. In contrast to many of these entities, CTCs do--when asymptomatic--not require any invasive work-up or even surgical excision. Read More

Otolaryngol Clin North Am 2015 Feb;48(1):1-14

Department of Pediatric Otolaryngology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA.

Branchial cleft anomalies are a common cause of congenital neck masses and can present as a cyst, sinus, or fistula. A comprehensive understanding of the embryologic basis of these anomalies aids in diagnosis and surgical excision. Fistulas tend to present at an earlier age than sinuses or cysts, with most lesions presenting as either a neck mass, draining sinus, or recurrent infections. Read More

Int J Clin Exp Pathol 2014 15;7(10):7059-63. Epub 2014 Sep 15.

Department of Radiotherapy, The First Affiliated Hospital, College of Medicine, Zhejiang University Zhejiang 310003, China.

We herein present a case of a left cervical cystic mass, for which the initial pathological diagnosis was branchial cleft cyst carcinoma (following complete mass excision). Thorough postoperative examinations, including with FDG positron emission tomography/computed tomography (PET/CT), revealed a primary tumor in the retromolar region of the left mandible. A 52-year-old female presented with a 2-month history of a painless, progressively enlarged left-sided neck mass. Read More

Ear Nose Throat J 2014 Oct-Nov;93(10-11):466-8

Department of Pediatric Otolaryngology, Children's Hospital of Michigan, 3901 Beaubien St., Detroit, MI 48201.

Branchial cleft anomalies make up 30% of all pediatric neck masses, but complete second branchial cleft anomalies are extremely rare. We report an unusual case of a complete second branchial cleft anomaly that presented as a draining neck fistula and a tonsillar cyst in an otherwise healthy 3-month-old girl. At the age of 7 months, the patient had been experiencing feeding difficulties, and there was increasing concern about the risk of persistent infections. Read More

Fetal Pediatr Pathol 2015 Feb 20;34(1):65-9. Epub 2014 Oct 20.

1University of Florence and Children's University Hospital, Department of emergency, Critical Area and Pediatric surgery , Viale Pieraccini 24, Florence , Italy.

Cervical thymic cysts are rare cervical masses which usually present in the first decade of life accounting for 0.3% - 1% of all congenital neck masses. Due to its rarity thymic cysts are seldom included in the differential diagnosis of cystic cervical mass and are often mistaken for more common conditions such as branchial cleft cyst or cystic hygroma. Read More

Ann R Coll Surg Engl 2014 Oct;96(7):e8-10

La Princesa University Hospital, Madrid, Spain.

The primitive thymus and inferior parathyroid derive from the third branchial cleft. During embryonic development, these structures descend, reaching their final localisation. Third branchial cleft anomalies present usually as a fistula, abscess or cyst. Read More

J Oral Maxillofac Surg 2014 Dec 24;72(12):2547-55. Epub 2014 May 24.

Professor, Department of Otolaryngology-Head and Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China. Electronic address:

Purpose: Second branchial cleft cysts have usually been resected through a prominent incision over the entire protruding zone. The resultant scar can be esthetically displeasing. We report on the endoscope-assisted excision of second branchial cleft cysts by way of a posterior occipital approach. Read More