Please choose a workflow. A standard workflow allows you to browse the repository with full case detail; the academic workflow allows you to browse the repository with limited case detail revealed. Double click on the images to launch image viewer.
4th Branchial Sinus
Case Detail
| Anatomy: Neck-Face |
 Joseph Junewick, MD FACR |
| Diagnostic Category: Developmental or Congenital |
|
| Created: over 2 years ago |
|
| Updated: over 2 years ago |
|
| Tags:
PEDS
|
|
| Modality/Study Types:
CT
|
|
Activities:  PDF  ImageJA |
History
Previously well 3 year old with painful neck mass and fever.
Case Images
Diagnosis
4th Branchial Sinus
Findings
CT – Axial and coronal reformatted images demonstrate complex fluid collection with irregular enhancing rim extending from the piriform sinus to the suprastenal notch. A few bubbles of air are also present. The left lobe of the thyroid is heterogeneous. The airway is deviated to the right but not effaced.
Discussion
The branchial apparatus is a series of mesodermal arches separated externally by ectoderm (branchial clefts) and internally by endoderm (pharyngeal pouches). Branchial anomalies are vestigial remnants resulting from incomplete obliteration of the branchial apparatus or buried epithelial rests.
Branchial anomalies are classified as cysts (no internal or external communication), sinuses (internal or external drainage with or without a cyst) or fistulas (internal and external communication with or without a cyst). Anatomic location can help differentiate the branchial arch origin.
Fourth branchial anomalies extend from the pyriform sinus to the mediastinum and penetrate the thyrohyoid membrane. Fourth branchial anomalies are cradled by the superior and recurrent laryngeal nerves and often course through the thyroid gland. Differential diagnoses include: laryngocele, suppurative adenitis, suppurative thyroiditis, and foreign body reaction.
Reference
Benson MT et al. Congenital anomalies of the branchial apparatus: Embryology and pathologic anatomy. Radiographics (1992); 12(5):943-960.