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Clinical Problem Solving: Radiology |

Radiology Quiz Case 1

Gopinathan Anil, MD, FRCR
Arch Otolaryngol Head Neck Surg. 2011;137(10):1035. doi:10.1001/archoto.2011.166-a.
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A 35-year-old South-East Asian woman presented with a 2-week history of a left upper cervical mass that had become painful and slightly tender over the previous 2 days. The mass was diagnosed as an infected second branchial cleft cyst (BCC) on an ultrasonogram obtained at an outside institution. Her total leukocyte count was mildly elevated to 11.5/μL (to convert to ×109/L, multiply by 0.001), with neutrophilia. A contrast-enhanced computed tomogram (CT) of the neck showed a 3.6 × 3.0 × 3.0-cm, solitary, well-circumscribed, cystic mass with a thick enhancing rim and a few enhancing internal septations. The mass was located behind the angle of mandible, posterior to the left submandibular gland, superficial to the carotid and jugular vessels, and anteromedial to the sternomastoid muscle (Figure 1 and Figure 2). Minimal fat stranding around the lesion and mild thickening of the overlying platysma were noted. A 1.5 × 1.0-cm nonspecific rounded hypodensity was also seen in the left lobe of the thyroid gland (Figure 2). No other significant abnormality was observed. Ultrasonography-guided aspiration of the cystic neck mass and fine-needle aspiration biopsy of the thyroid nodule were performed for histopathologic confirmation of the diagnosis.

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