Fourth branchial cleft cyst presenting as a mediastinal mass in a neonate: a case report
Introduction: Fourth branchial cleft anomalies are a rare congenital condition with varying presentations. Pediatricians and pediatric subspecialists must be familiar with this entity. Case presentation: A 4-day old term female presented with increased work of breathing. Exam was notable for intermi...
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Elsevier
2025-06-01
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| Series: | Journal of Pediatric Surgery Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213576625000624 |
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| author | Marisa E. Schwab Karthik Balakrishnan Stephanie D. Chao |
| author_facet | Marisa E. Schwab Karthik Balakrishnan Stephanie D. Chao |
| author_sort | Marisa E. Schwab |
| collection | DOAJ |
| description | Introduction: Fourth branchial cleft anomalies are a rare congenital condition with varying presentations. Pediatricians and pediatric subspecialists must be familiar with this entity. Case presentation: A 4-day old term female presented with increased work of breathing. Exam was notable for intermittent subcostal retractions. X-ray showed a mediastinal shadow. Chest CT showed a large mass extending from the neck into the mediastinum. Interventional radiology placed a pigtail into the mass via the left neck. This drained milky cloudy fluid for seven weeks. After transfer to a quaternary children's hospital, an MRI showed a persistent large thick-walled cyst tracking into the neck.Laryngoscopy, bronchoscopy and esophagoscopy initially didn't show anomalies. Methylene blue dye was injected into the drain and seen to exit from a left pyriform sinus tract. This was confirmed with on-table fluoroscopy.Two days later, she underwent injection of sclerosing agents and contrast via the drain under fluoroscopy. The sinus tract was cauterized and suture ligated using laryngoscopy. Laryngoscopy a few days later revealed no patent sinus tract. Sclerosant was again injected. Ultrasound after one month showed a slightly decreased mediastinal mass. Ultrasound three months later was significantly decreased size. At 7-month follow-up, the patient remains asymptomatic, feeding and growing well. Conclusion: Fourth branchial anomalies are rare but must be considered in a pediatric patient of any age presenting with a neck or mediastinal mass. |
| format | Article |
| id | doaj-art-b19d289ee66c437a8908bfaaf77206cb |
| institution | OA Journals |
| issn | 2213-5766 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
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| series | Journal of Pediatric Surgery Case Reports |
| spelling | doaj-art-b19d289ee66c437a8908bfaaf77206cb2025-08-20T02:20:12ZengElsevierJournal of Pediatric Surgery Case Reports2213-57662025-06-0111710301710.1016/j.epsc.2025.103017Fourth branchial cleft cyst presenting as a mediastinal mass in a neonate: a case reportMarisa E. Schwab0Karthik Balakrishnan1Stephanie D. Chao2Division of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, USA; Corresponding author. Division of Pediatric Surgery, Stanford University School of Medicine, 453 Quarry Road, 4th Floor Palo Alto, CA, 94304, USA.Department of Otolaryngology — Head & Neck Surgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, USADivision of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, USAIntroduction: Fourth branchial cleft anomalies are a rare congenital condition with varying presentations. Pediatricians and pediatric subspecialists must be familiar with this entity. Case presentation: A 4-day old term female presented with increased work of breathing. Exam was notable for intermittent subcostal retractions. X-ray showed a mediastinal shadow. Chest CT showed a large mass extending from the neck into the mediastinum. Interventional radiology placed a pigtail into the mass via the left neck. This drained milky cloudy fluid for seven weeks. After transfer to a quaternary children's hospital, an MRI showed a persistent large thick-walled cyst tracking into the neck.Laryngoscopy, bronchoscopy and esophagoscopy initially didn't show anomalies. Methylene blue dye was injected into the drain and seen to exit from a left pyriform sinus tract. This was confirmed with on-table fluoroscopy.Two days later, she underwent injection of sclerosing agents and contrast via the drain under fluoroscopy. The sinus tract was cauterized and suture ligated using laryngoscopy. Laryngoscopy a few days later revealed no patent sinus tract. Sclerosant was again injected. Ultrasound after one month showed a slightly decreased mediastinal mass. Ultrasound three months later was significantly decreased size. At 7-month follow-up, the patient remains asymptomatic, feeding and growing well. Conclusion: Fourth branchial anomalies are rare but must be considered in a pediatric patient of any age presenting with a neck or mediastinal mass.http://www.sciencedirect.com/science/article/pii/S2213576625000624Case reportBranchial cleft anomalyPyriform sinusMediastinal mass |
| spellingShingle | Marisa E. Schwab Karthik Balakrishnan Stephanie D. Chao Fourth branchial cleft cyst presenting as a mediastinal mass in a neonate: a case report Journal of Pediatric Surgery Case Reports Case report Branchial cleft anomaly Pyriform sinus Mediastinal mass |
| title | Fourth branchial cleft cyst presenting as a mediastinal mass in a neonate: a case report |
| title_full | Fourth branchial cleft cyst presenting as a mediastinal mass in a neonate: a case report |
| title_fullStr | Fourth branchial cleft cyst presenting as a mediastinal mass in a neonate: a case report |
| title_full_unstemmed | Fourth branchial cleft cyst presenting as a mediastinal mass in a neonate: a case report |
| title_short | Fourth branchial cleft cyst presenting as a mediastinal mass in a neonate: a case report |
| title_sort | fourth branchial cleft cyst presenting as a mediastinal mass in a neonate a case report |
| topic | Case report Branchial cleft anomaly Pyriform sinus Mediastinal mass |
| url | http://www.sciencedirect.com/science/article/pii/S2213576625000624 |
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