Second Branchial Cleft Cyst

  • Etiology: remnant of embryonal branchial arch incompletely obliterated, courses from posterior to submandibular gland and anteromedial to sternocleidomastoid muscle and lateral to carotid space
  • Imaging: look between sternocleidomastoid muscle and submandibular gland
  • US: internal debris may look more solid
  • CT: low density, notch sign (cyst extension between internal carotid artery / external carotid artery bifurcation), if it has thick wall or contrast enhancement think infection
  • MRI: T1 hypointense, T2 hyperintense, no contrast enhancement
  • Clinical: 90% of branchial cleft cysts

Radiology Cases of Second Branchial Cleft Cyst

Clinical Cases of Second Branchial Cleft Cyst

Clinical image of second branchial cleft sinus
Clinical images show a punctate cyst at the anterior border of the right sternocleidomastoid muscle (above) that with some massaging is seen to emit fluid (below).