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Spinelli C, Ghionzoli M, Ugolini C, Oreglio C, Guglielmo C, Morabito A, Patrizio A, Fallahi P, Ferrari SM, Antonelli A. Does thyroglossal duct arborization play a role in the post-surgical outcome of Sistrunk procedure in children? Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08631-y. [PMID: 38594507 DOI: 10.1007/s00405-024-08631-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE The purpose of the present study is to analyze thyroglossal duct cyst (TGDC) histopathological features, with focus on "arborization", in a cohort of pediatric patients who underwent surgical removal, and evaluate a possible correlation with clinical recurrences. METHODS A retrospective analysis of all patients who underwent surgical resection for TGDC at the division of Pediatric Surgery of the University of Pisa from 2015 to 2020 was performed; for each patient, the following data were recorded: age, sex, clinical presentation, localization, size of the lesion, diagnostic tools, histopathological features, perioperative complications, recurrence and follow-up. RESULTS With respect to arborization, following histopathological analysis 25/30 patients (83.3%) presented thyroglossal duct branching. After a median follow-up of 3.5 years, only 2 out of 30 patients (6.7%), one male and one female, respectively aged 4 y.o. and 6 y.o., presented recurrence within one year from first surgery. CONCLUSION Surgery for TGDC remains a challenge for pediatric surgeons, while arborization was present in most of our cases which underwent surgery. With respect to the role of arborization, our study did not highlight sufficient conclusive data regarding their role in recurrence: instead, it showed wide resection as satisfactory, being the arborization present in most of the cases at histopathology.
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Affiliation(s)
- Claudio Spinelli
- Division of Pediatric and Adolescent Surgery, Department of Surgery, University of Pisa, Pisa, Italy
| | - Marco Ghionzoli
- Division of Pediatric and Adolescent Surgery, Department of Surgery, University of Pisa, Pisa, Italy
| | - Clara Ugolini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italia
| | - Chiara Oreglio
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Carla Guglielmo
- Division of Pediatric and Adolescent Surgery, Department of Surgery, University of Pisa, Pisa, Italy
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Armando Patrizio
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Alessandro Antonelli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italia.
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2
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O'Brien WT. Common Neck and Otomastoid Infections in Children. Neuroimaging Clin N Am 2023; 33:661-671. [PMID: 37741664 DOI: 10.1016/j.nic.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Neck infections are common in children, though the clinical presentation is often vague and nonspecific. Therefore, imaging plays a key role in identifying the site and extent of infections, evaluating for potentially drainable collections, and assessing for airway and vascular complications. This review focuses on imaging features associated with common and characteristic neck infections in children to include tonsillar, retropharyngeal, and otomastoid infections; suppurative adenopathy; superimposed inflammation or infection of congenital cystic lesions; and Lemierre syndrome.
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Affiliation(s)
- William T O'Brien
- Division of Pediatric Neuroradiology, Orlando Health - Arnold Palmer Hospital for Children, 92 West Miller Street, Orlando, FL 32806, USA.
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3
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Aristizabal MA. Fourth Branchial Cleft Cyst: An Important Differential Diagnosis in Lateral Neck Masses. Cureus 2023; 15:e36913. [PMID: 37139277 PMCID: PMC10151110 DOI: 10.7759/cureus.36913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Branchial anomalies are a result of abnormal development during embryogenesis and are a rare cause of lateral neck masses of congenital origin. The second branchial cleft is the most common site of origin, with abnormalities arising from the first, third, and fourth clefts being rarer. Although cysts originating from branchial clefts are infrequent, it is important to consider this pathology in the differential diagnosis of neck masses, particularly those located laterally. This article discusses a rare case of a 49-year-old female patient who presented with the sudden appearance of a lateral neck mass after sports practice. The patient underwent extensive diagnostic studies, including radiological studies, which were compatible with a fourth branchial cleft cyst. The patient remains asymptomatic, and possible surgical treatment is being evaluated by the head and neck surgery service. This clinical case highlights the importance of prompt diagnosis and appropriate management of rare pathologies such as branchial cleft cysts.
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Multispecialty Approach to a Very Large Congenital Head and Neck Cystic Lymphatic Malformation in an Infant Born by SARS-CoV-2 Positive Mother—A Case Report. Biomedicines 2022; 10:biomedicines10102422. [DOI: 10.3390/biomedicines10102422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022] Open
Abstract
Masses of the head and neck are often diagnosed prenatally and require special care due to the risk of airway obstruction. The EXIT procedure is a preferable mode of delivery. A congenital cystic lymphatic malformation is one of the most common lesions of the cervical region described in neonates. The treatment consists of different strategies and involves the cooperation of multiple specialists. Up to now, no guidelines or protocols are available. We report a case of a congenital cystic lymphatic malformation of the head and neck delivered during the EXIT procedure by a mother who was SARS-CoV-2 positive. We analyzed clinical characteristics, radiologic features, and treatment with injections of sclerotic agents and orally administrated sirolimus. Sirolimus seems a valuable and safe therapeutic option for treating lymphatic malformations, especially with adjunct therapies.
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Cordes M, Coerper S, Kuwert T, Schmidkonz C. Ultrasound Imaging of Cervical Anatomic Variants. Curr Med Imaging 2021; 17:966-972. [PMID: 33504311 PMCID: PMC8653420 DOI: 10.2174/1573405617666210127162328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
Embryologic developmental variants of the thyroid and parathyroid glands may cause cervical anomalies that are detectable in ultrasound examinations of the neck. For some of these developmental variants, molecular genetic factors have been identified. Ultrasound, as the first-line imaging procedure, has proven useful in detecting clinically relevant anatomic variants. The aim of this article was to systematically summarize the ultrasound characteristics of developmental variants of the thyroid and parathyroid glands as well as ectopic thymus and neck cysts. Quantitative measures were developed based on our findings and the respective literature. Developmental anomalies frequently manifest as cysts that can be detected by cervical ultrasound examinations. Median neck cysts are the most common congenital cervical cystic lesions, with a reported prevalence of 7% in the general population. Besides cystic malformations, developmental anomalies may appear as ectopic or dystopic tissue. Ectopic thyroid tissue is observed in the midline of the neck in most patients and has a prevalence of 1/100,000 to 1/300,000. Lingual thyroid accounts for 90% of cases of ectopic thyroid tissue. Zuckerkandl tubercles (ZTs) have been detected in 55% of all thyroid lobes. Prominent ZTs are frequently observed in thyroid lobes affected by autoimmune thyroiditis compared with normal lobes or nodular lobes (P = 0.006). The correct interpretation of the ultrasound characteristics of these variants is essential to establish the clinical diagnosis. In the preoperative assessment, the identification of these cervical anomalies via ultrasound examination is indispensable.
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Affiliation(s)
- Michael Cordes
- Nuklearmedizinische Klinik, Universitätsklinikum Erlangen, Germany
| | - Stephan Coerper
- Klinik für Chirurgie, Martha-Maria-Krankenhaus, Nürnberg, Germany
| | - Torsten Kuwert
- Nuklearmedizinische Klinik, Universitätsklinikum Erlangen, Germany
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6
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Role of prenatal imaging in the diagnosis and management of fetal facio-cervical masses. Sci Rep 2021; 11:1385. [PMID: 33446872 PMCID: PMC7809128 DOI: 10.1038/s41598-021-80976-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/29/2020] [Indexed: 12/01/2022] Open
Abstract
Congenital facio-cervical masses can be a developmental anomaly of cystic, solid, or vascular origin, and have an inseparable relationship with adverse prognosis. This retrospective cross-sectional study aimed at determining on the prenatal diagnosis of congenital facio-cervical masses, its management and outcome in a large tertiary referral center. We collected information on prenatal clinical data, pregnancy outcomes, survival information, and final diagnosis. Out of 130 cases of facio-cervical masses, a total of 119 cases of lymphatic malformations (LMs), 2 cases of teratoma, 2 cases of thyroglossal duct cyst, 4 cases of hemangioma, 1 case of congenital epulis, and 2 cases of dermoid cyst were reviewed. The accuracy of prenatal ultrasound was 93.85% (122/130). Observations of diameters using prenatal ultrasound revealed that the bigger the initial diameter is, the bigger the relative change during pregnancy. Magnetic resonance imaging (MRI) revealed that 2 cases of masses were associated with airway compression. In conclusion, ultrasound has a high overall diagnostic accuracy of fetal face and neck deformities. Prenatal US can enhance the management of ambulatory monitoring and classification. Furthermore, MRI provided a detailed assessment of fetal congenital malformations, as well as visualization of the trachea, presenting a multi-dimensional anatomical relationship.
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Abstract
Imaging plays a leading role in detection and diagnosis of fetal head and neck lesions. These lesions comprise a heterogeneous group of congenital tumors and malformations. Complementary imaging modalities that can be used in prenatal medicine are ultrasound and MRI. The authors discuss imaging characteristics of fetal lesions, assessment of potential complications and pregnancy management options for the most common pathology of the fetal head and neck.
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Beichner TL, Speer B, Carpenter JW, Reavill DR. Surgical Management of an Intrathoracic Branchial Cyst in a Yellow-crested Cockatoo ( Cacatua sulphurea). J Avian Med Surg 2020; 33:289-295. [PMID: 31893625 DOI: 10.1647/2018-368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 40-year-old, female lesser crested cockatoo (Cacatua sulphurea) was presented with a complaint of hyporexia and sudden onset of sneezing and wheezing. Physical examination revealed mild stertorous inhalation, and the apex of the heart was palpable caudoventral to the distal tip of the sternum. Projection radiographic images showed a soft tissue mass displacing the heart and the thoracic portion of the trachea. A subsequent computed tomography series revealed a single, large, and predominantly encapsulated soft-tissue mass. The mass was contained within the cranial thoracic region and occupied most of the anatomic location of the thoracic portion of the clavicular air sac, extending around a portion of the trachea. A surgical exploratory procedure was performed, with a thoracic inlet thoracotomy, and the mass was found to be cystic and deeply attached to surrounding tissues at its caudal-most aspect. Complete excision was not possible, and the mass was drained and an incomplete resection was accomplished with approximately one-half of the cystic structure removed and submitted for histopathology. The mass was found to be benign, epithelial-lined, dense, fibrous connective tissue that would be consistent with a branchial cyst.
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Affiliation(s)
- Timothy L Beichner
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66505, USA
| | - Brian Speer
- The Medical Center for Birds, Oakley, CA 94561, USA
| | - James W Carpenter
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66505, USA
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9
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Pitak-Arnnop P, Subbalekha K, Sirintawat N, Auychai P, Klaisiri A, Neff A. Intraoperative injection of combined fibrin sealant and methylene blue dye for surgery of branchial cleft cysts: A case report. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 120:378-382. [PMID: 30797901 DOI: 10.1016/j.jormas.2019.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 02/05/2019] [Accepted: 02/13/2019] [Indexed: 12/17/2022]
Abstract
Differential diagnosis of a lateral neck mass, especially in paediatric patients, should include branchial cleft cysts (BrCC). It is often difficult to identify and completely resect all cystic components, especially when the lesion becomes infected and/or gigantic. Incomplete excision increases the likelihood of recurrences. We reported a simple technique to facilitate the BrCC resection. Tisseel fibrin glue (FG: Baxter AG, Vienna, Austria) was mixed with methylene blue dye in inverse portion to the cyst size and/or the FG volume before injecting into the cystic lumen. After polymerisation of the dyed glue, the lesion was better visualised and extirpated in toto with the aid of the dye colour and gelatinisation by FG. An up-to-date diagnostic and therapeutic algorithm for BrCC was also presented.
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Affiliation(s)
- P Pitak-Arnnop
- Department of Oral and Maxillofacial, UKGM GmbH, University Hospital of Marburg, Faculty of Medicine, Philipps University, Marburg, Germany.
| | - K Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - N Sirintawat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - P Auychai
- Department of Paediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - A Klaisiri
- Divisions of Operative Dentistry and Material Science, Faculty of Dentistry, Thammasat University, Pathumthani, Thailand
| | - A Neff
- Department of Oral and Maxillofacial, UKGM GmbH, University Hospital of Marburg, Faculty of Medicine, Philipps University, Marburg, Germany
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10
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Ahn D, Lee GJ, Sohn JH. Ultrasonographic Characteristics of Pyriform Sinus Fistulas Involving the Thyroid Gland. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2631-2636. [PMID: 30099745 DOI: 10.1002/jum.14623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Ultrasonography (US) has been considered to have a more limited role in the diagnosis of pyriform sinus fistulas than computed tomography. The aim of this study was to evaluate the US characteristics of pyriform sinus fistulas involving the thyroid gland in an attempt to improve our ability to diagnose this condition using US. METHODS Between 2005 and 2016, 14 patients with pyriform sinus fistulas presenting as suppurative thyroiditis or as thyroid nodules were enrolled in the study. Their US images were reviewed to identify US characteristics indicating the presence of an underlying pyriform sinus fistula and compared with the computed tomographic images. RESULTS A hypoechoic tubular lesion across the thyroid gland was identified in 9 patients (64.3%). Hyperechoic foci or echogenic lines were found within the lesion in 10 patients (71.4%). A hypoechoic rim was found at the boundary of the lesion in 7 patients (50.0%). A lesion emerging from the posterolateral aspect of the thyroid cartilage was found in 4 patients (28.6%). Thirteen (92.9%) of the 14 patients had 1 of these 4 findings. CONCLUSIONS Ultrasonography would be a useful diagnostic modality for indicating the presence of an underlying pyriform sinus fistula in patients with suppurative thyroiditis or a thyroid nodule and can be used as a first-line diagnostic tool to screen for pyriform sinus fistulas.
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Affiliation(s)
- Dongbin Ahn
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Gil Joon Lee
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Ho Sohn
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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11
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Bocchialini G, Bozzola A, Daleffe F, Ferrari L, Castellani A. Unusually rapid development of a lateral neck mass: Diagnosis and treatment of a branchial cleft cyst. A case report. Int J Surg Case Rep 2017; 41:383-386. [PMID: 29545997 PMCID: PMC5697997 DOI: 10.1016/j.ijscr.2017.10.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction Branchial cleft cysts are benign lesions caused by anomalous development of the branchial cleft. Cases that arise in the lateral neck region are often misdiagnosed, resulting initially in inappropriate management. Case presentation We describe a 32-year-old woman with a swelling on the right side of her neck and no pain during palpation or neck motion. Discussion The patient was evaluated using fine-needle aspiration cytology (FNAC), ultrasound, and magnetic resonance imaging (MRI) scans. The MRI showed a right-sided cervical mass with hyperintense content, well-defined margins, and no evidence of infiltration into surrounding structures, while FNAC found a yellow, pus-like fluid, keratinised anuclear cells, squamous epithelium, and a matrix of amorphous debris. Conclusion Based on the images and the patient's symptoms, a surgical intervention was performed.
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Affiliation(s)
| | - Anna Bozzola
- Department of Molecular and Translational Medicine, Section of Pathology, University Spedali Civili Di Brescia, Spedali Civili di Brescia, Unità Operativa di Anatomia Patologica, Brescia, Italy
| | | | - Luca Ferrari
- Maxillo-Facial Pediatric Surgery Unit, ASST Spedali Civili, Brescia, Italy
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12
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Igoumenakis D, Logothetis I, Barmpagadaki A, Ieromonachou P, Mastorakis G. Temporal Space Lymphatic Malformation in a 15-Year-Old Adolescent: An Extraordinary Case. J Maxillofac Oral Surg 2016; 15:274-8. [PMID: 27408452 DOI: 10.1007/s12663-015-0789-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 03/23/2015] [Indexed: 11/29/2022] Open
Abstract
Lymphatic malformations-previously called lymphangiomas or cystic hygromas-are regarded as non-malignant primary disorders of the lymphatic system. They appear predominantly in infants and children, with 90 % of cases being diagnosed by the age of 2 years. Also, they constitute an infrequent entity, accounting for 5 % of all benign tumors in infants and children. In adults they are extremely rare. In the present article we present an extraordinary case of a lymphatic malformation that ensued in the temporal area of a 15-year old adolescent.
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Affiliation(s)
- Dimosthenis Igoumenakis
- Department of Oral and Maxillofacial Surgery, General Hospital of Attica "KAT", 2 Nikis Street, 14561 Kifisia, Athens, Greece
| | - Ioannis Logothetis
- Department of Oral and Maxillofacial Surgery, Venizeleio-Pananeio General Hospital of Heraklion, Knossos Avenue, P.O. Box 44, Heraklion, Crete, Greece
| | | | - Panayotis Ieromonachou
- Department of Pathology, Venizeleio-Pananeio General Hospital of Heraklion, Knossos Avenue, P.O. Box 44, Heraklion, Crete, Greece
| | - George Mastorakis
- Department of Oral and Maxillofacial Surgery, Venizeleio-Pananeio General Hospital of Heraklion, Knossos Avenue, P.O. Box 44, Heraklion, Crete, Greece
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Sloand ED, Boeckner L, DeSell MNL. Pediatric Branchial Cleft Cysts: A Case Study. J Pediatr Health Care 2016; 30:155-9. [PMID: 26292642 DOI: 10.1016/j.pedhc.2015.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/13/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
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LaPlante JK, Pierson NS, Hedlund GL. Common pediatric head and neck congenital/developmental anomalies. Radiol Clin North Am 2015; 53:181-96. [PMID: 25476180 DOI: 10.1016/j.rcl.2014.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pediatric head and neck neuroradiology is a broad and complex topic. This article focuses on several of the common and sometimes challenging pediatric head and neck congenital/developmental anomalies physicians may encounter in clinical practice. Although some diagnoses may be evident on physical examination, others may present a diagnostic dilemma. Patients may initially present with a variety of secondary findings. Imaging serves an important role in making a diagnosis, guiding referral, and in some cases even providing treatment options through interventional radiology. Key diagnostic criteria and critical points of interest for each diagnosis are presented.
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Affiliation(s)
- Justin K LaPlante
- Department of Neuroradiology, University of Utah, 30 North 1900 East, #1A071, Salt Lake City, UT 84132, USA.
| | - Nicholas S Pierson
- Department of Neuroradiology, University of Utah, 30 North 1900 East, #1A071, Salt Lake City, UT 84132, USA
| | - Gary L Hedlund
- Department of Pediatric Medical Imaging, Primary Children's Hospital, Intermountain Healthcare, 100 No. Mario Capecchi Drive, Salt Lake City, UT 84113, USA
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Gaddikeri S, Vattoth S, Gaddikeri RS, Stuart R, Harrison K, Young D, Bhargava P. Congenital Cystic Neck Masses: Embryology and Imaging Appearances, With Clinicopathological Correlation. Curr Probl Diagn Radiol 2014; 43:55-67. [DOI: 10.1067/j.cpradiol.2013.12.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
We describe a 23-year-old man with a cystic hygroma on the right side of his lower neck. Cystic hygromas are uncommon congenital lesions of the lymphatic system and are often diagnosed before the age of 2. The finding of a cystic hygroma is rare in adults. We report the results regarding a cystic hygroma in a 23-year-old man. An initial physical examination was performed, followed by an ultrasound examination and CT. Surgical excision was the treatment of choice. Adequate imaging and physical examination of lateral neck masses in adults are needed to confirm the diagnosis.
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17
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Hu S, Hu CH, Yang L, Xing JM, Chen JH, Ge ZL, Liu JS. Atypical imaging observations of branchial cleft cysts. Oncol Lett 2013; 7:219-222. [PMID: 24348852 PMCID: PMC3861601 DOI: 10.3892/ol.2013.1656] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 10/30/2013] [Indexed: 11/22/2022] Open
Abstract
The aim of the present study was to assess the atypical imaging manifestations of branchial cleft cysts (BCCs) confirmed by pathology. Computerized tomography (CT) or magnetic resonance imaging (MRI) of 17 BCC cases were reviewed. The imaging features, including laterality, location, border, attenuation and internal architecture, were evaluated. All 17 cases were second BCCs, including 5 cases of Bailey type I classification cysts and 12 cases of type II classification cysts. The atypical imaging features included signal and morphological abnormalities. The abnormal signal intensities were caused by intracapsular bleeding (n=2) or solidification of cystic fluid (n=2). Intracystic hemorrhaging revealed homogeneous hyperintensity on T1-weighted image (T1WI) and T2-weighted image (T2WI). Solidification of cystic fluid revealed slightly homogeneous hyperintensity compared with muscle on T1WI and homogeneous hypointensity on T2WI without enhancement. The aberrant morphology mainly presented as thickening of the cystic wall (n=13). Thickened walls of BCCs with ill- (n=5) or well- (n=8) defined borders were observed in 13 patients. In 3 patients, significant enhancement was identified following intravenous gadolinium administration (n=4). When with atypical CT or MRI features are presented, the typical location of BCCs can help in the diagnosis, as it is located at the lateral portion of the neck adjacent to the anterior border of the mandibular angle or sternocleidomastoid muscle. The atypical observations, including variable signals, imply that the cystic content has changed. Thickened walls indicate inflammation or cancerous tendency and patients with ill-defined margins, vascular involvement or lymphadenopathy atelectasis indicate malignant conversion.
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Affiliation(s)
- Su Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Chun-Hong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Ling Yang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Jian-Ming Xing
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Jian-Hua Chen
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Zi-Li Ge
- Department of Oral Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Ji-Sheng Liu
- Department of Otorhinolaryngology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
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18
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Gonzalez-Perez LM, Prats-Golczer VE, Montes Carmona JF, Heurtebise Saavedra JM. Bilateral first branchial cleft anomaly with evidence of a genetic aetiology. Int J Oral Maxillofac Surg 2013; 43:296-300. [PMID: 24042065 DOI: 10.1016/j.ijom.2013.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 03/17/2013] [Accepted: 05/20/2013] [Indexed: 11/28/2022]
Abstract
Anomalies of the first branchial cleft (FBC) are uncommon, and recognizing them can be difficult. Although present at birth, many cases do not become evident until later in childhood or adolescence, with an initial clinical presentation in adulthood being encountered only rarely. Typically, FBC anomalies present as a unilateral cyst, sinus, or fistula associated with the external auditory canal, or with swelling or an inflammatory opening in the peri-auricular/parotid area. They are commonly misdiagnosed and are often treated inadequately before being excised completely. A 40-year-old woman presented to the maxillofacial outpatient clinic with an episode of bilateral pre-auricular tumefaction, initially diagnosed as temporomandibular dysfunction syndrome. This was associated with bilateral pre-auricular pain that increased with mandibular movements. In relation to the patient's history, and given the bilateral presence of a pre-auricular pit, a diagnosis of FBC anomaly was made. Further investigation showed a related asymptomatic history in five other cases across four generations of the same family. The authors describe here the case, the diagnostic methodology, and the wide local excision technique used for removal of the branchial sinus.
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Affiliation(s)
- L M Gonzalez-Perez
- Department of Oral and Maxillofacial Surgery, "Virgen del Rocio" University Hospital, Seville, Spain.
| | - V E Prats-Golczer
- Department of Oral and Maxillofacial Surgery, "Virgen del Rocio" University Hospital, Seville, Spain
| | - J F Montes Carmona
- Department of Oral and Maxillofacial Surgery, "Virgen del Rocio" University Hospital, Seville, Spain
| | - J M Heurtebise Saavedra
- Department of Oral and Maxillofacial Surgery, "Virgen del Rocio" University Hospital, Seville, Spain
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Abstract
Branchial cleft cysts are benign lesions caused by anomalous development of the brachial cleft. This report describes a 20-year-old girl with swelling on the right lateral aspect of the neck, which expanded slowly but progressively. The clinical suspicion was that of a branchial cleft cyst. Sonography revealed a homogeneously hypo- to anechoic mass with well-defined margins and no intralesional septa. Color Doppler reviewed no internal vascularization. The ultrasound examination confirmed the clinical diagnosis of a second branchial cleft cyst, demonstrating the cystic nature of the mass and excluding the presence of complications. For superficial lesions like these, ultrasound is the first-level imaging study of choice because it is non-invasive, rapid, low-cost, and does not involve exposure to ionizing radiation.
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20
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Abstract
Cystic masses of neck consist of a variety of pathologic entities. The age of presentation and clinical examination narrow down the differential diagnosis; however, imaging is essential for accurate diagnosis and pretreatment planning. Ultrasound is often used for initial evaluation. Computed tomography (CT) provides additional information with regard to the extent and internal composition of the mass. Fine-needle aspiration cytology (FNAC) has a supplementary role for confirmation of diagnosis. Magnetic resonance imaging may be needed in some cases for preoperative assessment.
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Affiliation(s)
- Mahesh Kumar Mittal
- Department of Radiodiagnosis and Imaging, VMMC and Safdarjung Hospital, New Delhi, India
| | - Amita Malik
- Department of Radiodiagnosis and Imaging, VMMC and Safdarjung Hospital, New Delhi, India
| | - Binit Sureka
- Department of Radiodiagnosis and Imaging, VMMC and Safdarjung Hospital, New Delhi, India
| | - Brij Bhushan Thukral
- Department of Radiodiagnosis and Imaging, VMMC and Safdarjung Hospital, New Delhi, India
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21
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Shekdar KV, Mirsky DM, Kazahaya K, Bilaniuk LT. Magnetic resonance imaging of the pediatric neck: an overview. Magn Reson Imaging Clin N Am 2012; 20:573-603. [PMID: 22877956 DOI: 10.1016/j.mric.2012.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Evaluation of neck lesions in the pediatric population can be a diagnostic challenge, for which magnetic resonance (MR) imaging is extremely valuable. This article provides an overview of the value and utility of MR imaging in the evaluation of pediatric neck lesions, addressing what the referring clinician requires from the radiologist. Concise descriptions and illustrations of MR imaging findings of commonly encountered pathologic entities in the pediatric neck, including abnormalities of the branchial apparatus, thyroglossal duct anomalies, and neoplastic processes, are given. An approach to establishing a differential diagnosis is provided, and critical points of information are summarized.
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Affiliation(s)
- Karuna V Shekdar
- Division of Neuroradiology, Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 324 South 34th Street, Philadelphia, PA 19104, USA.
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