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2nd Branchial Cleft Cyst
Bernadette L. Koch, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • 2nd branchial cleft cyst (BCC)
            • Synonyms

              • 2nd branchial apparatus cyst (BAC)
              • 2nd branchial apparatus anomaly (BAA)
            • Definitions

              • 2nd BCC: Most common branchial apparatus cyst
                • Cystic remnant of cervical sinus of His: Derivative of 2nd, 3rd, & 4th branchial clefts
              • Sinus: Usually communicates externally along anterior margin of sternocleidomastoid muscle (SCM)
                • Rarely communicates internally to tonsillar fossa
              • Fistula: Communicates externally and internally
                • Secondary to persistence of both branchial cleft and pharyngeal pouch remnant
              • Combinations
                • Cyst ₊ sinus &/or fistula

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Chen LS et al: Endoscope-assisted versus conventional second branchial cleft cyst resection. Surg Endosc. 26(5):1397-402, 2012
                                          2. Goff CJ et al: Current management of congenital branchial cleft cysts, sinuses, and fistulae. Curr Opin Otolaryngol Head Neck Surg. 20(6):533-9, 2012
                                          3. Bajaj Y et al: Branchial anomalies in children. Int J Pediatr Otorhinolaryngol. 75(8):1020-3, 2011
                                          4. Buchanan MA et al: Cystic schwannoma of the cervical plexus masquerading as a type II second branchial cleft cyst. Eur Arch Otorhinolaryngol. 266(3):459-62, 2009
                                          5. Hudgins PA, Gillison M. Second branchial cleft cyst: not!! AJNR Am J Neuroradiol. 30(9):1628-9, 2009
                                          6. Gupta AK et al: Bilateral first and second branchial cleft fistulas: a case report. Ear Nose Throat J. 87(5):291-3, 2008
                                          7. Koch BL: Cystic malformations of the neck in children. Pediatr Radiol. 35(5):463-77, 2005
                                          8. Lanham PD et al: Second brachial cleft cyst mimic: case report. AJNR Am J Neuroradiol. 26(7):1862-4, 2005
                                          9. Kemperman MH et al: Evidence of progression and fluctuation of hearing impairment in branchio-oto-renal syndrome. Int J Audiol. 43(9):523-32, 2004
                                          10. Ceruti S et al: Temporal bone anomalies in the branchio-oto-renal syndrome: detailed computed tomographic and magnetic resonance imaging findings. Otol Neurotol. 23(2):200-7, 2002
                                          11. Choo MJ et al: A case of second branchial cleft cyst with oropharyngeal presentation. J Korean Med Sci. 17(4):564-5, 2002
                                          12. Kemperman MH et al: Inner ear anomalies are frequent but nonobligatory features of the branchio-oto-renal syndrome. Arch Otolaryngol Head Neck Surg. 128(9):1033-8, 2002
                                          13. Shin JH et al: Parapharyngeal second branchial cyst manifesting as cranial nerve palsies: MR findings. AJNR Am J Neuroradiol. 22(3):510-2, 2001
                                          14. Lev S et al: Imaging of cystic lesions. Radiol Clin North Am. 38(5):1013-27, 2000
                                          15. Nusbaum AO et al: Recurrence of a deep neck infection: a clinical indication of an underlying congenital lesion. Arch Otolaryngol Head Neck Surg. 125(12):1379-82, 1999
                                          16. Ahuja A et al: Solitary cystic nodal metastasis from occult papillary carcinoma of the thyroid mimicking a branchial cyst: a potential pitfall. Clin Radiol. 53(1):61-3, 1998
                                          17. McDermott ID et al: Metastatic papillary thyroid carcinoma presenting as a typical branchial cyst. J Laryngol Otol. 110(5):490-2, 1996
                                          18. Choi SS et al: Branchial anomalies: a review of 52 cases. Laryngoscope. 105(9 Pt 1):909-13, 1995
                                          19. Benson MT et al: Congenital anomalies of the branchial apparatus: embryology and pathologic anatomy. Radiographics. 12(5):943-60, 1992
                                          20. Doi O et al: Branchial remnants: a review of 58 cases. J Pediatr Surg. 23(9):789-92, 1988
                                          21. Salazar JE et al: Second branchial cleft cyst: unusual location and a new CT diagnostic sign. AJR Am J Roentgenol. 145(5):965-6, 1985
                                          22. Harnsberger HR et al: Branchial cleft anomalies and their mimics: computed tomographic evaluation. Radiology. 152(3):739-48, 1984
                                          23. Gold BM: Second branchial cleft cyst and fistula. AJR Am J Roentgenol. 134(5):1067-9, 1980
                                          24. Poswillo D: The pathogenesis of the first and second branchial arch syndrome. Oral Surg Oral Med Oral Pathol. 35(3):302-28, 1973
                                          25. Bailey H: The clinical aspect of branchial cysts. In: Branchial Cysts and Other Essays on Surgical Subjects in the Facio-cervical Region. London: H.K. Lewis. 1-18, 1929
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • 2nd branchial cleft cyst (BCC)
                                                    • Synonyms

                                                      • 2nd branchial apparatus cyst (BAC)
                                                      • 2nd branchial apparatus anomaly (BAA)
                                                    • Definitions

                                                      • 2nd BCC: Most common branchial apparatus cyst
                                                        • Cystic remnant of cervical sinus of His: Derivative of 2nd, 3rd, & 4th branchial clefts
                                                      • Sinus: Usually communicates externally along anterior margin of sternocleidomastoid muscle (SCM)
                                                        • Rarely communicates internally to tonsillar fossa
                                                      • Fistula: Communicates externally and internally
                                                        • Secondary to persistence of both branchial cleft and pharyngeal pouch remnant
                                                      • Combinations
                                                        • Cyst ₊ sinus &/or fistula

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Ultrasonographic Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Chen LS et al: Endoscope-assisted versus conventional second branchial cleft cyst resection. Surg Endosc. 26(5):1397-402, 2012
                                                                                  2. Goff CJ et al: Current management of congenital branchial cleft cysts, sinuses, and fistulae. Curr Opin Otolaryngol Head Neck Surg. 20(6):533-9, 2012
                                                                                  3. Bajaj Y et al: Branchial anomalies in children. Int J Pediatr Otorhinolaryngol. 75(8):1020-3, 2011
                                                                                  4. Buchanan MA et al: Cystic schwannoma of the cervical plexus masquerading as a type II second branchial cleft cyst. Eur Arch Otorhinolaryngol. 266(3):459-62, 2009
                                                                                  5. Hudgins PA, Gillison M. Second branchial cleft cyst: not!! AJNR Am J Neuroradiol. 30(9):1628-9, 2009
                                                                                  6. Gupta AK et al: Bilateral first and second branchial cleft fistulas: a case report. Ear Nose Throat J. 87(5):291-3, 2008
                                                                                  7. Koch BL: Cystic malformations of the neck in children. Pediatr Radiol. 35(5):463-77, 2005
                                                                                  8. Lanham PD et al: Second brachial cleft cyst mimic: case report. AJNR Am J Neuroradiol. 26(7):1862-4, 2005
                                                                                  9. Kemperman MH et al: Evidence of progression and fluctuation of hearing impairment in branchio-oto-renal syndrome. Int J Audiol. 43(9):523-32, 2004
                                                                                  10. Ceruti S et al: Temporal bone anomalies in the branchio-oto-renal syndrome: detailed computed tomographic and magnetic resonance imaging findings. Otol Neurotol. 23(2):200-7, 2002
                                                                                  11. Choo MJ et al: A case of second branchial cleft cyst with oropharyngeal presentation. J Korean Med Sci. 17(4):564-5, 2002
                                                                                  12. Kemperman MH et al: Inner ear anomalies are frequent but nonobligatory features of the branchio-oto-renal syndrome. Arch Otolaryngol Head Neck Surg. 128(9):1033-8, 2002
                                                                                  13. Shin JH et al: Parapharyngeal second branchial cyst manifesting as cranial nerve palsies: MR findings. AJNR Am J Neuroradiol. 22(3):510-2, 2001
                                                                                  14. Lev S et al: Imaging of cystic lesions. Radiol Clin North Am. 38(5):1013-27, 2000
                                                                                  15. Nusbaum AO et al: Recurrence of a deep neck infection: a clinical indication of an underlying congenital lesion. Arch Otolaryngol Head Neck Surg. 125(12):1379-82, 1999
                                                                                  16. Ahuja A et al: Solitary cystic nodal metastasis from occult papillary carcinoma of the thyroid mimicking a branchial cyst: a potential pitfall. Clin Radiol. 53(1):61-3, 1998
                                                                                  17. McDermott ID et al: Metastatic papillary thyroid carcinoma presenting as a typical branchial cyst. J Laryngol Otol. 110(5):490-2, 1996
                                                                                  18. Choi SS et al: Branchial anomalies: a review of 52 cases. Laryngoscope. 105(9 Pt 1):909-13, 1995
                                                                                  19. Benson MT et al: Congenital anomalies of the branchial apparatus: embryology and pathologic anatomy. Radiographics. 12(5):943-60, 1992
                                                                                  20. Doi O et al: Branchial remnants: a review of 58 cases. J Pediatr Surg. 23(9):789-92, 1988
                                                                                  21. Salazar JE et al: Second branchial cleft cyst: unusual location and a new CT diagnostic sign. AJR Am J Roentgenol. 145(5):965-6, 1985
                                                                                  22. Harnsberger HR et al: Branchial cleft anomalies and their mimics: computed tomographic evaluation. Radiology. 152(3):739-48, 1984
                                                                                  23. Gold BM: Second branchial cleft cyst and fistula. AJR Am J Roentgenol. 134(5):1067-9, 1980
                                                                                  24. Poswillo D: The pathogenesis of the first and second branchial arch syndrome. Oral Surg Oral Med Oral Pathol. 35(3):302-28, 1973
                                                                                  25. Bailey H: The clinical aspect of branchial cysts. In: Branchial Cysts and Other Essays on Surgical Subjects in the Facio-cervical Region. London: H.K. Lewis. 1-18, 1929