Fourth branchial pouch anomaly presenting as a neonatal neck lump

Area of Science:

• Pediatric Surgery
• Otolaryngology
• Developmental Biology

Background:

• Branchial anomalies are congenital malformations that can present as neck masses.
• Fourth branchial pouch anomalies are rare and often misdiagnosed.
• Infantile neck lumps require careful differential diagnosis.

Observation:

• A 1-week-old infant presented with a transilluminating neck lump that enlarged with crying.
• Initial differential diagnoses included lymphatic malformation, abscess, or necrotic tumor.
• Imaging suggested possibilities of abscess or necrotic tumor.

Findings:

• Biopsy indicated a developmental cyst with local inflammation.
• Microlaryngoscopy identified a fourth branchial pouch sinus.
• Cauterization of the sinus led to complete resolution of the neck lump.

Implications:

• This case highlights the importance of considering rare branchial anomalies in infantile neck masses.
• Early diagnosis and targeted treatment of branchial pouch sinuses can prevent complications.
• Successful management of this rare condition underscores the efficacy of minimally invasive techniques.