Infected 2nd branchial cleft cyst
Left-sided neck swelling since 1.5 months. currently painful with dyspnoea. Recent ultrasound shows left-sided neck cystic lesion deep to the left sternomastoid muscle with echogenic turbid fluid content.
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A well-defined left neck cystic lesion exhibits near-water density with an enhancing wall of non-uniform thickness, measuring 4.5 x 4.2 x 5.2 cm. Laterally, the lesion is in intimate relation to the left sternomastoid muscle, inseparable from its medial wall. Anteriorly, it is indenting the posterior surface of the left submandibular gland. Medially, it is related to the carotid sheath with compression and caliber attenuation of the left internal jugular vein. Multiple bilateral reactive cervical lymph nodes are noted. The ipsilateral parotid gland is of normal CT features.
The described CT features are most likely representing infected second branchial cleft cyst type II, the most common type of this congenital anomaly. Classically, it is located at the anteromedial border of the sternocleidomastoid muscle, lateral to the carotid space, and at the posterior margin of the submandibular gland, related to the angle of the mandible. The location can be anywhere from the pharyngeal wall to the skin along the course of the second branchial apparatus.