11yrs/m boy presents with swelling in rt neck region and had history of small swelling noticed at age of 3 yrs. swelling has increased progressively within 5 days and larynx and tracheal pushed laterally from midline and pain over neck region. o/e warm, tenderness, soft present diagnosis? d/d management??

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Step by step 1.small swelling noticed at 3 years of age . It is a branchial cyst . 2.It cannot be cystic hygroma as it is never small swelling 3.Sudden increase in size with on 5 days indicates secondary infection in a branchial cyst with branchial abscess formation 4 A USG will confirm the diagnosis 5 Incision and drainage of branchial abscess is indicated under cover of parenteral antibiotics. 6 Once drainage is complete and wound has healed definitive surgery for branchial cyst can be deferred for 6 months


Tnx Dr Kapil Chavan

It seems to be a cystic one as noticed at 3 years of age it was small in size it has to be a branchial cyst only difference with the cystic hygroma which not a small one. As it increase in 5 days there may be some infection in the cyst forming an abscess as there was pain. As suspecting abscess it must be drained under coverage of higher antibiotic. Once the pus drained out it will heal up in due course of time later at least after 6 months branchial cyst can be exised.

Hogidkins lymphoma good results with prednisolon otherwise radiotherapy is tt of choice 2 nd d/ d is tuberclar lymhnodes after matting for this has to be investigated for t b cbc esr mtwith 5 t u sputam for afb cxr Igm specific for tb P. S . For hodgkin inbloo slide u can see mirror image cells 3 / d/d is abscess wheather cold or hot if cold treat with att if hot then incesin & drain. Anti biotics antiinflamatory analgesics

Swelling classically in the upper lateral part of neck..noted at 3..slowly growing..now he is 11..(possibly congenital/Benign)Sudden increased sizein days (likely infectious). No pit or sinus(a cyst)..Very likely Bronchial( Pharyngeal) cleft cyst. Bronchial means =Gills as in fish. If any one masters these and their derivatives...Essentially Head and structures.6 arches..5th degenerates. 1st essentially (Mandibular arch)..form external ear canal..and malleus and incus. The most common is 2nd Bronchial related Cyst pr sinus.All these charecteristically lie on the anterior border of Sternocleidomasyoid muscle.Even though these are congenital may make their presence later as is in this case.Here in picture looks more over lateral ..may more of infectious swelling than origional cyst. Cystic hygroma classically I am correct.. Is lateral to (posterior) to SCM. 3rd and 4th may play role in Aortic and Thymic dysplasias .This case is a brain teaser for us who forget applied anotomy. This young lady has given us chance to brush up very important topic of pharyngeal arches and pouches.By now she must be knowing the definitive diagnosis..if she followed up the case and I hope write conclusion about the case....For just discussion purposes..Lympnode mass/ Lipoma/Hemangioma/Dermoid may present Like nevk swelling but I pressume they are not D/D for the case.I pressume this is 2 nd Bronchial cleft cyst complicated by Bacterial infection and abscess formation. Which is very common .One precaution Metastatic tumors of Toungue Base/Laryngeal/Pharyngeal/Thyroid carcinomas may present as swellings in that locations In adults.

DD Branchial cyst. Tubercular lymphadenitis Cystic hygroma.

Rt cervical Lymphadenopathy.. CBCESR, acourse of Antibiotics. Review reports. FNAC finally will help.

cystic hygroma hodkins reactive lymphadenitis are dds

It's a Brachial cyst. USG to confirm the diagnosis.

Physical exam.fnac will decide.could be Hodgkin. Lipoma or tubercular lymphadenopathy

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