A 30yo man presents with a 5cm neck mass anterior to the sternocleido-mastoid muscle on the
left side in its upper third. He states that the swelling has been treated with antibiotics for
infection in the past. What’s the most likely cause?
a. Branchial cyst
b. Parotitis
c. Pharyngeal pouch
d. Thyroglossal cyst
answer: A
A branchial cyst usually presents in early adult life
and forms a soft swelling ‘ like a half - filled hot
water bottle ’ , which bulges forward from beneath
the anterior border of the sternocleidomastoid. It
is lined by squamous epithelium and contains
pus - like material, which is in fact cholesterol. It
often presents following an upper respiratory tract
infection. Clinical diagnosis can be clinched by
aspirating a few drops of this fluid from the cyst
and demonstrating cholesterol crystals under the
microscope. Occasionally, the cyst may become
infected.
Differential diagnosis is from a tuberculous
gland of the neck or from an acute
lymphadenitis.
The rare first branchial arch cyst may present
just below the external auditory meatus at the
angle of the jaw, with extension closely related to
the VII nerve.
A branchial sinus presents as a small orifice, discharging
mucus, which opens over the anterior
border of the sternocleidomastoid in the lower
part of the neck. The majority are present at
birth but a secondary branchial sinus may form.
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