20 year old girls with recent neck mass

 

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Doctor's Information

Name : Hamidreza
Family : Haghighatkhah
Affiliation :Radiology department,ShohadaTajrish Hospital,SBMU
Academic Degree : Associate professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Sayed Mohammad Emrani

 

Case Section

Head & Neck Imaging

 

Patient's Information

Gender : Female
Age : 20

 

Clinical Summary

20 year old girls with recent neck mass

 

Imaging Findings

A cystic hypodense lesion between carotid sheath and SCM in right sided with faint peripheral enhancement and a adjustment reactive lymph node in posterior region. A lytic lesion in right mandible adjecent apex of the root of a tooth.

 

Differential Diagnosis

necrotic lymph node

 

Final Diagnosis

Branchial Cleft Cyst attached to a reactive lymph node/. The apical or radicalar cyst

 

Discussion (Related Text)

Branchial Cleft Cyst Special attention has to be given to the diagnosis of the second branchial cyst (the Bailey type II cyst, which is secondary to persistence of the embryologic cervical sinus) as the most common developmental mass identified on imaging and the most common branchial cleft anomaly. It appears as an intermittent, soft)!fW_db[ii!cWii!Wbed]!j^[!Yekhi[!e\!j^[!Wdj[h_eh!cWhgin of the sternocleidomastoid muscle that affects children as well as teenagers and young adults. The classic location of the second branchial cyst, which is actually a branchial apparatus remnant, is in the posterior submandibular space at the angle of mandible . In contrast, the type III second branchial cleft cyst courses between the external and internal carotid arteries. The most specific imaging characteristic of the lesion is the displacement of the submandibular gland anteromedially, the carotid space medially, and the sternocleidomastoid muscle posterolaterally. The lesions appear cystic on CT imaging and show a bright signal on the T2-weighted images. T1-weighted signal is variable depending on the protein content of the cyst. Enhancement is usually present in infected cysts, in which case cellulitis may appear in the surrounding soft tissues. Septations are uncommon and are usually found only in cases of previous infection or needle aspiration. Infected cysts may mimic necrotic jugular chain lymph nodes or cervical abscesses on both CT and MRI. Mandibular and maxillary cysts often seem to present a problem to the medical radiologist, yet their diagnosis is essentially simple. There are three commonly seen cystic lesions : a. The apical or radicalar cyst. This is by far the most common. It sits on the very apex of the root of a tooth, which is usually carious. . b. The dentigerous or !i4licular cyst, which is a cyst related to the crown of an unerupted tooth. c. The primordial or odonto'e nic ke ratoc.vst. This often develops in place of a tooth and may reach a very large size, but is not as common as the dentigerous cyst. In addition, central or midline cysts tend to he fissural or developmental in origin. When a cyst arises on a tooth related to the floor of the maxilla. the cyst extends into the maxillary antrum and appears rather like a polyp. The floor of the antrum is displaced upward. by the cyst, however, and its upper surface is thus a thin dense line, unlike a polyp. Aspiration of the contents and insertion of contrast medium confirms the cystic nature of the lesion.

 

References

John R.Haaga , CT and MRI of the whole body , fifth edition 2009 , page 658

 

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