DISNEA COMO ÚNICO SÍNOTMA DE UN QUISTE BRANQUIAL

Abstract

INTRODUCTION: Most of the branchial cysts (>90%) come from the second branchial arch. These are originated from an embryonic defect consisting of the lack of fusion between de second branchial arch and the basal portion of the fourth cleft, causing the interiorization of the ectodermic tissue of the laterocervical area. The cyst and the fistula may sometimes go from the medium area of the sternocleidomastoid (SCM) muscle to the tonsillar region. Rarely, they appear in the childhood and they are usually asymptomatic. Only if the cyst is infected, the patient consults about the appearance of a laterocervical tumor. Surgery is the treatment of this disease when symptomatic by removing the cyst and its fistulae, if it exists. METHODS: A 52-year-old patient goes to Emergency department to discard the presence of a left peritonsillar abscess. The patient doesn’t report odynophagia, dysphagia, trismus nor fever. The only symptom he reports is dyspnea in supine decubitus. When he is checked, a great bulging of the anterior tonsillar pillar is seen, blocking nearly all the oropharyngeal space and moving the uvula to the right. An aspiration-puncture is made without purulence drainage. When an endoscopy is made, the hypopharynx and larynx are medializated. A CT scan shows the presence of a left parapharyngeal cystic mass, with a 5.1x2.5cm diameter, surrounded by a thin wall that captures contrast. It is located medially to de SCM muscle and between the internal and external left carotids, blocking the airway. This tumor is suitable for a second cleft branchial cyst. An elective surgery is decided, performing a left cervicotomy to partially remove and marsupialize the cyst. Nowadays, the patient has a left Horner syndrome because of the handling of the carotid during the surgery. CONCLUSIONS: The second branchial arch cysts are the most frequent branchial cysts. When a peritonsillar abscess is suspected and no typical symptoms are featured, a second branchial cyst may be included in the differential diagnosis. The use of images is very important to confirm the diagnosis and acknowledge the patient’s anatomy in order to prepare a surgery.