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Branchial cysts: an unusual cause of a mediastinal mass: a case report.

Kotecha V, Muturi A, Ruturi J - J Med Case Rep (2015)

Bottom Line: We present the a case of an 8-year-old boy, a primary school pupil, from rural Kenya with chronic cough, wheezing, difficulty in breathing and dyspnea on exertion.He was treated with antibiotics and antitubercular drugs without improvement prior to referral to our hospital.Surgical excision is the mainstay of treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University of Nairobi, 30197, Nairobi, 00100, Kenya. viharkotecha@hotmail.com.

ABSTRACT

Introduction: Complex embryological processes form the head and neck of humans. It is not flawless; remnants lead to sinuses or cysts, commonly in the head and neck region.

Case presentation: We present the a case of an 8-year-old boy, a primary school pupil, from rural Kenya with chronic cough, wheezing, difficulty in breathing and dyspnea on exertion. He was treated with antibiotics and antitubercular drugs without improvement prior to referral to our hospital. A computed tomography scan of his chest revealed a superior mediastinal mass extending into his neck. A diagnosis of a brachial cleft cyst was made and our patient underwent a successful excision of the mass through a median strenotomy and neck dissection.

Conclusions: Branchial cysts of the neck are common, accounting for 20% of pediatric neck masses. Usually they present as a neck mass but in our case it presented as a mediastinal mass, which is a very rare clinical presentation. Surgical excision is the mainstay of treatment. To the surgeon, the embryology and anatomy should be absolutely clear as dissection may be challenging due to the close proximity and variable course of the cystic stalk to major neck vessels and nerves.

No MeSH data available.


Related in: MedlinePlus

Computed tomography scan of the chest
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Fig2: Computed tomography scan of the chest

Mentions: The chest X-ray done at the district hospital after no improvement on anti-TB medication showed a widened mediastinum without features of PTB (Fig. 1). His hemogram and erythrocyte sedimentation rate were normal. A chest computed tomography (CT) scan was done upon admission to our unit. It showed a cystic mass in the superior mediastinum. It appeared to be arising from the neck at the level of the thyroid cartilage deep to the sternocleidomastoid muscle and extending into the mediastinum to the level of the carina. The mass displaced the major neck vessels (Fig. 2). The lung parenchyma and the heart were reported as normal, with no pleural effusion. The radiologist reported a differential diagnosis of branchial cleft cyst and thymoma.Fig. 1


Branchial cysts: an unusual cause of a mediastinal mass: a case report.

Kotecha V, Muturi A, Ruturi J - J Med Case Rep (2015)

Computed tomography scan of the chest
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4587576&req=5

Fig2: Computed tomography scan of the chest
Mentions: The chest X-ray done at the district hospital after no improvement on anti-TB medication showed a widened mediastinum without features of PTB (Fig. 1). His hemogram and erythrocyte sedimentation rate were normal. A chest computed tomography (CT) scan was done upon admission to our unit. It showed a cystic mass in the superior mediastinum. It appeared to be arising from the neck at the level of the thyroid cartilage deep to the sternocleidomastoid muscle and extending into the mediastinum to the level of the carina. The mass displaced the major neck vessels (Fig. 2). The lung parenchyma and the heart were reported as normal, with no pleural effusion. The radiologist reported a differential diagnosis of branchial cleft cyst and thymoma.Fig. 1

Bottom Line: We present the a case of an 8-year-old boy, a primary school pupil, from rural Kenya with chronic cough, wheezing, difficulty in breathing and dyspnea on exertion.He was treated with antibiotics and antitubercular drugs without improvement prior to referral to our hospital.Surgical excision is the mainstay of treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University of Nairobi, 30197, Nairobi, 00100, Kenya. viharkotecha@hotmail.com.

ABSTRACT

Introduction: Complex embryological processes form the head and neck of humans. It is not flawless; remnants lead to sinuses or cysts, commonly in the head and neck region.

Case presentation: We present the a case of an 8-year-old boy, a primary school pupil, from rural Kenya with chronic cough, wheezing, difficulty in breathing and dyspnea on exertion. He was treated with antibiotics and antitubercular drugs without improvement prior to referral to our hospital. A computed tomography scan of his chest revealed a superior mediastinal mass extending into his neck. A diagnosis of a brachial cleft cyst was made and our patient underwent a successful excision of the mass through a median strenotomy and neck dissection.

Conclusions: Branchial cysts of the neck are common, accounting for 20% of pediatric neck masses. Usually they present as a neck mass but in our case it presented as a mediastinal mass, which is a very rare clinical presentation. Surgical excision is the mainstay of treatment. To the surgeon, the embryology and anatomy should be absolutely clear as dissection may be challenging due to the close proximity and variable course of the cystic stalk to major neck vessels and nerves.

No MeSH data available.


Related in: MedlinePlus