Thyroglossal duct cyst: Variable presentations

Abstract

BackgroundThyroglossal duct cysts are the most common cause of midline congenital cyst formation in the neck that may present at any age. Classically, it presents as an anterior midline neck swelling that moves with deglutition and protrusion of the tongue. Occasionally, thyroglossal duct cyst presents in atypical manner either clinically or radiologically, which may pose a diagnostic challenge. ObjectiveThe aim of this study is to review cases diagnosed with thyroglossal duct cysts as regards clinical and radiological presentation, focusing on cases with atypical presentation. Patients and methodsThe medical records of patients who were diagnosed with thyroglossal duct cysts from January 2004 till October 2007 were retrospectively reviewed. A total of 22 patients were included in the study. They were classified as typical and atypical according to the clinical and radiological presentation. ResultsThere were 10 males (45.5%) and 12 females (54.5%) with mean age of 17.3 years. The site of the cyst was infrahyoid in 20 cases (91%), suprahyoid in one case (4.5%) and intralingual in one case (4.5%). Clinically, 16 cases (72.7%) showed typical presentation and six cases (27.3%) were atypical in the form of: thyroglossal duct cyst with intralaryngeal extension, intralingual cyst, ruptured cyst with subsequent chronic inflammatory changes within the anterior neck compartment, thyroglossal duct cyst with intracystic solid mass, inferiorly located cyst that was mobile with deglutition but not with tongue protrusion, and thyroglossal duct cyst presenting as lateral neck swelling. Radiologically, T2 weighted magnetic resonance imaging was the only radiological modality that showed a tract extending to the tongue base. ConclusionThyroglossal duct cyst should be considered in the differential diagnosis of any anterior neck swelling. T2 weighted magnetic resonance imaging is the most informative radiological modality. It can be used to differentiate cysts with atypical presentation from other neck swellings.