A Rare Case of A Mass on the Neck that Changes its Dimensions When Weeping

Abstract

When branchial clefts and pouches do not atrophy between 4 and 7 weeks of fetal life or when an anomalous or incomplete fusion occurs, congenital neck anomalies may develop. We present a rare case of a mass resembling a branchial sinus on the right side of the neck of a 2-month-old baby, which originated from the fourth branchial arch-derived structuresand varies in size with weeping. A 2-month-old boy was brought with a complaint of a congenital swelling on his neck. His physical examination revealed a cyst on the right lower region of the neck, which swelled when he wept, and prolonged neonatal jaundice. On computed tomographyof the neck, a formation consistent with a branchial cleft cyst originating from the right jugulodigastric region extending up to the right infraclavicular region and to the pyriform sinus was observed. The child was maintained under surveillance. Branchial cysts account for 30% of congenital neck cysts in children. Masses derived from the fourth branchial arch are more frequently seen on the left side. In our patient, this rare mass was localized on the right side of the neck and was diagnosed when the baby was 2 months old. During the Valsalva maneuver, pyriform sinuses fill with air passing through their orifices and consequently the size of the mass varies in size. Third and fourth branchial sinus anomalies should be considered in neck masses whose size changes with Valsalva maneuver.

Keywords

• Branchial cyst
• neck mass
• valsalva