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Infrahyoid Neck Cystic Lesions
A 2-year-old girl presenting with fever and a mass in her neck for 24 hours. Ax , axial; Cor , coronal; CT, computed tomography; Sag , sagittal.
A 2-month-old girl presenting with swelling in the left side of the neck, a mass, and firm induration. Ax , axial; Cor , coronal; CT, computed tomography; Sag , sagittal.
A 23-year-old woman with a history of papillary thyroid carcinoma. Ax , axial; Cor , coronal; CT, computed tomography; Sag , sagittal.
A 29-year-old man presenting with hemoptysis and abnormal chest radiograph findings. Ax , axial; Cor , coronal; CT, computed tomography; Sag , sagittal.
DESCRIPTION OF FINDINGS
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Case A features a round, low-attenuation lesion containing air that is centered within the left lobe of the thyroid gland with peripheral ring enhancement.
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Case B features a large, irregularly shaped, heterogeneously enhancing mass with central hypodensity in the left side of the neck that extends from the base of the skull to the supraclavicular region. The mass anteriorly displaces and is adherent to the left sternocleidomastoid muscle and is closely associated with the parotid gland. Surrounding fat stranding and fascial thickening are present.
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Case C features a cystic mass with a prominently enhancing nodule and a few foci of calcification located in the posterior cervical triangle, lying deep to the left sternocleidomastoid muscle and deep and inferior to the parotid gland. Multiple surgical clips and calcifications are noted in the lower anterior neck in the expected location of the thyroid gland.
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In Case D, multiple large, low-density masses with thick, peripheral enhancement are located along the right posterior cervical lymph node chain. One of the masses has a prominent central calcification.
Diagnosis
Case A
Thyroid abscess from a third or fourth branchial apparatus remnant or fistula
Case B
Suppurative lymphadenitis (the clinical and imaging differential diagnosis included lymphadenitis and an infected branchial cleft cyst)
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