Branchial Cleft Cyst: A Case Study in a Thirteen Year Old Girl

Abstract Background: Second branchial cleft cysts are the most common branchial cleft lesions, found near the anterior upper one-third aspect of the sternocleidomastoid muscle. Branchial sinuses or fistulae are often found after birth, but internal sinus tracts and branchial cleft cysts may be found later in life. Although branchial clefts are resectable, the surgeries become more complicated following an infection. We report a case of a patient with a second branchial cleft cyst with a previous infection, leading to a difficult resection. Case information: A 13-year-old female patient presented to her pediatrician with tender mass on the left side of her neck for two days. She denied fever, fatigue, weight loss, or cat scratches. Her boyfriend had Infectious Mononucleosis a few weeks prior. Her labs revealed a normal Epstein-Barr Virus panel and a negative mononucleosis spot test, rapid strep A test, and Bartonella Henselae Antibodies. Her erythrocyte sedimentation rate and C-reactive protein were elevated. She completed a course of clindamycin and azithromycin, but the mass remained. A chest x-ray revealed clear lungs. Her MRI with contrast showed a mass which her otolaryngologist identified as a branchial cleft cyst. The resection was complicated due to her previous infection; the cyst was adherent to the great vessels, the accessory nerve and the sternocleidomastoid. The patient recovered uneventfully. Conclusions: Branchial cleft cysts account for approximately 20-30% of all pediatric neck masses. If a patient presents with a neck mass, health care providers should consider branchial cleft anomalies in the differential diagnosis. Knowledge about branchial cleft cysts and their presentation will help health care providers ensure these patients receive appropriate management more rapidly, thus avoiding some of the challenges and risks of surgical excision once infection has occurred.