8 year odynophagia John J DeBevits IV MD Infected 4 th branchial cleft cyst Mild tracheal deviation Piriform sinus effacement Fistula Abscess Note how the abscess is intimately involve ID: 938223
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8 - year - old boy with fever and odynophagia John J. DeBevits IV, MD ? Infected 4 th branchial cleft cyst Mild tracheal deviation Piriform sinus effa
cement ?Fistula Abscess • Note how the abscess is intimately involved with the thyroid gland. • Again we see mild tracheal deviation to the right
4 th branchial cleft cyst • Very rare lesions, accounting for only 1 - 4% of all branchial cleft anomalies • Typically present in early childhood,
typically secondary to superimposed acute, suppurative thyroiditis or recurrent abscess formation. • Almost always involves the upper left thyroid l
obe • Commonly results in fistulous connection with the piriform sinus • The course of the cyst may extend inferiorly and wrap around the aortic a
rch on the left or subclavian artery from the right 4 th branchial cleft cyst Imaging findings • No pathognomonic findings • Requires solid under
standing of the types of arch malformations and their locations • May be helpful to perform a barium swallow combined with a CT neck study after th
e barium swallow • Dx should be considered in a pt with persistent cyst or fistula in the head and neck and correlate this with appropriate clinica
l history and exam Differential diagnosis • Cervical thymic cyst • Lymphatic malformation • Thyroglossal duct cyst • Thyroid colloid cyst •
Abscess References • http://appliedradiology.com/articles/congen ital - cystic - lesions - of - the - neck/congenital - cystic - lesions - of - the -