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Pediatric Neck Swelling: A Case Report of Fourth Branchial Cleft Cyst
Noor I Al-Thawwab1, Maryam J Alhashim1, Ghaida S Alharbi2
1General Practice, Imam Abdulrahman Bin Faisal University, Dammam, SAU.
Insights
A rare fourth branchial cleft cyst caused an abscess in a pediatric neck mass. Prompt diagnosis and surgical excision are crucial for treating this uncommon pediatric inflammatory condition.
Area of Science:
- Pediatric Surgery
- Head and Neck Surgery
- Developmental Biology
Background:
- Pediatric neck masses pose diagnostic challenges due to diverse etiologies.
- Branchial cleft anomalies are rare congenital malformations arising from incomplete embryonic development.
Observation:
- A seven-year-old boy presented with fever and a rapidly enlarging left anterior cervical mass.
- Physical examination revealed a fluctuant, non-tender swelling.
- Imaging and aspiration confirmed an abscess secondary to a fourth branchial cleft cyst.
Findings:
- Computed tomography revealed a hypodense, rim-enhancing mass.
- Ultrasound-guided aspiration identified *Staphylococcus aureus* infection.
- This case underscores fourth branchial cleft cysts as a cause of pediatric inflammatory neck masses.
Implications:
- Understanding the embryological basis of branchial cleft anomalies is key to recognizing their varied presentations.
- Surgical excision is the definitive treatment for symptomatic branchial cleft cysts.
- Management requires careful consideration of anatomical complexities in pediatric patients.
Abstract:
Pediatric neck masses present a diagnostic challenge, encompassing various etiologies, including rare entities like branchial cleft anomalies. Branchial cleft cysts, resulting from incomplete embryonic cleft obliteration, may become symptomatic. This case report describes a seven-year-old boy who presented with a week-long history of fever and progressively enlarging left anterior cervical swelling. Physical examination revealed a fluctuant, non-tender mass, prompting diagnostic investigations. Laboratory results indicated an elevated white blood cell count and inflammatory markers. Computed tomography identified a hypodense, rim-enhancing mass consistent with an abscess secondary to a fourth branchial cleft cyst. Ultrasound-guided aspiration yielded purulent material, confirming Staphylococcus aureus infection. This case highlights the clinical significance of fourth branchial cleft cysts as rare inflammatory neck masses in pediatric patients. The embryological context informs their diverse anatomical manifestations. Surgical excision remains the primary treatment, demanding consideration of anatomical complexities.
