First branchial cleft cyst. There is a T1-hypointense and T2-hyperintense
cystic lesion involving the superficial lobe of the right parotid gland, as
seen on axial T1- and T2-weighted sequences (A and B, respectively).
Second Branchial Cleft Cyst. Axial non-contrast MRI images (above) and
sagittal contrast-enhanced MRI images below. There is a cystic mass filled
with a simple fluid surrounded by a homogeneously enhancing thin-wall in
the right neck anteriorly. The cyst is located anterior to the right
sternocleidomastoid muscle and inferoposterior to the right parotid gland
and is most consistent with a second branchial cleft cyst.
Recurrent abscess arising from 3rd branchial cleft cyst. Coronal (A) and axial (B and C)
postcontrast CT images of the neck show a peripherally enhancing fluid collection
extending from the left retropharyngeal space, into the thyroid strap muscles on the left,
along the anterior and lateral margin of the left thyroid lobe deep to the
sternocleidomastoid muscle, representing abscess arising from 3rd branchial cleft cyst.
Epidermoid cyst. (A) The axial contrast-enhanced CT scan shows a cystic attenuation lesion
centered in the floor of the mouth. (B) The axial and (C) Sagittal MR T2-weighted image
reveals a well-defined T2 hyper-intense lesion in the floor of the mouth in the same patient.
A 2-year-old boy with acute Suppurative thyroiditis. Contrast-enhanced CT
shows a fluid collection (arrows) with internal gas (arrowhead) involving
left lobe of thyroid gland (open arrows) and adjacent soft tissue.
Acquired dermoid cysts result from a part of the skin
being traumatically implanted in the deeper layers after
ectopic formation of a dermal cyst lined with squamous
Congenital inclusion dermoid cysts form along the lines
of embryologic fusion and contain both dermal and
Dermoid cysts of the head and neck are thought to be
the congenital inclusion type.
many cysts originate from the infundibular portion of the
hair follicle, and the more general term, epidermoid cyst,
part of the generalized syndrome of
NF-1, aka von Recklinssghausen disease
Believed to arise from Schwann cell but
Central low T2 signal
is characteristic of
Paraganglioma: Ultrasound with color Doppler, T1-weighted non-contrast MR and CECT
Lipoma & Lipoblastoma.
Rare benign mesynchymal tumor of embryonal fat
May clinically and radiologically mimic a hemangioma
Collections of lipoblasts –multivuolated w/ round nuclei
Lipoblastomatosis of the Neck.
Third most common pediatric cancer.
Incidence: 11-20 per million children.
Geographical variance – 50 % of
childhood cancers in equatorial Africa.
Due to high incidence of Burkett's
Male predominance 2.5:1.
Neuroblastoma, Mass (arrow) lateral to carotid artery (arrowhead).
Neuroblastoma. Axial proton-density-weighted image of the neck shows a
well-defined right neck mass in the carotid sheath deviating the carotid artery
and jugular vein anteriorly and mildly deviating the trachea to the left.
Initial evaluation (H&P)
Congenital, infectious, benign, malignant
Beware of tuberculosis, cat scratch
disease, atypical infections
Beware of systemic symptoms
Beware the supraclavicular mass
Consider FNA or biopsy in the mass that
does not resolve with treatment.