English

Abstract

Branchial cysts are congenital anomalies. Very few cases have been reported about branchial cysts with mediastinal extension. We report here a case of branchial cysts with mediastinal extension. INTRODUCTION: Branchial cysts (also known as lateral cervical cysts), predominantly present in the lateral aspect of the neck. Branchial cleft cysts are congenital anomalies. Typically, a fluctuant swelling is felt deep to the sternocleidomastoid at the junction of its upper third and lower two thirds. They often present in the second and third decades of life. No racial or sexual predilection has been identified. Males and females are equally affected and there is occasionally a hereditary tendency. Diagnosis is usually made clinically. Branchial cleft cysts are benign; however, super infection, mass effect, and surgical complications account for morbidity. Patients relate its discovery to an attack of pharyngitis, ear infection, or dental infection, and many report temporary enlargement with or without tenderness during periods of upper respiratory tract infection. Inflamed cysts may progress to abscess formation with the possibility that rupture or incision and drainage will lead to either permanent sinus formation or to recurrent cyst formation and infection. Recurrence rates are reported. CASE REPORT: A previously well 12 year old girl presented to outpatient department with a two month history of left sided neck swelling & associated symptoms of mild discomfort in the region of neck swelling & mild degree of odynophagia. There was no history of and respiratory compromise. Past medical history was unremarkable & she was on no regular medications. On examination, a large about 8x3 cm size left neck swelling noted limited posteriorly by the ipsilateral sternocleidomastoid muscle. The mass was soft in consistency, fluctuant & non-tender. No visualized engorged veins noted over the swelling. There was no evidence of fistula. No other mass or abdominal examinations were normal with no evidence of any organomegaly. The full blood counts were within normal limits. Chest X-ray was also unremarkable. A hematological referral was made & ultrasound of the neck was advised. USG –neck revealed a cystic mass in the left side of the neck extending inferiorly up to the ipsilateral supraclavicular region. The inferior most aspect of the lesion could not be delineated. For further evaluation a MRI scan of the neck was done on a Siemens MR scanner using IV contrast. Routine T1 wt. & T2 wt. as well as post contrast T1 wt. images were taken in axial, sagittal & coronal planes. Post contrast T1 wt. coronal image demonstrates a left sided neck mass with a hypointense centre & isointense peripheral margins & no evidence of any enhancements (Fig-1). T2 with axial image shows a hyperintense looking mass in the left side of neck limited posteriorly by the ipsilateral sternocleidomastoid muscle & it is also extending into the left Para pharyngeal space displacing the carotid vessels (Fig-2). T2 wt. coronal image demonstrates