Case report: Fourth branchial cleft cyst: a case of acute suppurative thyroiditis

Abstract

This case report presents a 4 year-old-female patient with a neck mass who was diagnosed with an infected fourth branchial cleft cyst with left thyroid lobe involvement through fistulation. The case emphasizes the importance of considering uncommon etiologies, such as congenital anomalies, as a differential diagnosis when evaluating pediatric neck masses. The patient was prescribed broad-spectrum antibiotics, which led to the regression of the mass and inflammatory signs. Close follow-up in endocrinology and otorhinolaryngology appointments was maintained, and after 7 months, hypoplasia of the left lobe was observed. Thyroid function was reevaluated, and after two years, no recurrences were noted. The case highlights the significance of a comprehensive examination and assessment of corresponding clinical features, which can significantly reduce the rate of misdiagnoses and achieve an individualized diagnosis.

Pediatric Neck Swelling: A Case Report of Fourth Branchial Cleft Cyst

“…The differential diagnosis for pediatric neck masses is broad, encompassing infectious, congenital, and neoplastic etiologies. Branchial cleft anomalies represent a spectrum of developmental abnormalities, with second-branchial cleft lesions being the most common, while third- and fourth-branchial anomalies are notably rare, collectively accounting for approximately 20% of cervical masses in pediatric populations [ 2 , 3 ].…”

“…The potential for recurrent infections and the development of fistula tracts pose challenges in management, with surgical intervention carrying the risk of injury to vital structures, particularly when the parotid is involved. The complexity of surgical considerations is underscored by the potential for facial nerve injury in cases involving the parotid region [ 3 ].…”