From the Archives of the AFIP
Congenital Cystic Masses of the Neck: Radiologic-Pathologic Correlation
Kelly K. Koeller, CDR, MC, USN1,2,
Leonor Alamo, MD2,1,
Carol F. Adair, LTC, MC, USA2,3 and
James G. Smirniotopoulos, MD2
1 Departments of Radiologic Pathology (K.K.K., L.A.)
2 Otolaryngic and Endocrine Pathology (C.F.A.), Armed Forces Institute of Pathology, Alaska and Fern Sts, Bldg 54, Rm M-121, Washington, DC 20306-6000
3 Departments of Radiology and Nuclear Medicine (K.K.K., J.G.S.)
4 Pathology (C.F.A.), Uniformed Services University of the Health Sciences, Bethesda, Md.
View larger version (39K):
[in a new window]
|
Figure 1. Pathway of the thyroglossal duct. Drawing shows a lateral view of the embryologic thyroglossal duct from the foramen cecum through the developing hyoid bone to the pyramidal lobe of the thyroid. If the duct fails to involute completely, a thyroglossal duct cyst may result, with 80% of these lesions being at or below the level of the hyoid bone. (Reprinted, with permission, from reference 5.)
|
|
View larger version (71K):
[in a new window]
|
Figure 2a. Persistent thyroglossal duct sinus tract in a 5-year-old boy who had undergone two partial resections for a thyroglossal duct cyst in the preceding 9 months. (a) Photograph of the lower neck shows a fistulous ostium with a transverse surgical scar on both sides. (b) CT scan obtained after ethiodized oil was injected into the fistula shows focal collection of the contrast agent in the region of the foramen cecum (arrow). (c, d) CT scans obtained at lower levels show the contrast material–enhanced path of the thyroglossal duct along the anterior surface of the hyoid bone (arrow in c) and inferiorly to the skin ostium near the pyramidal lobe of the thyroid (arrow in d). (e) Photograph of the surgical specimen reveals entire length of the fistulous tract.
|
|
View larger version (107K):
[in a new window]
|
Figure 2b. Persistent thyroglossal duct sinus tract in a 5-year-old boy who had undergone two partial resections for a thyroglossal duct cyst in the preceding 9 months. (a) Photograph of the lower neck shows a fistulous ostium with a transverse surgical scar on both sides. (b) CT scan obtained after ethiodized oil was injected into the fistula shows focal collection of the contrast agent in the region of the foramen cecum (arrow). (c, d) CT scans obtained at lower levels show the contrast material–enhanced path of the thyroglossal duct along the anterior surface of the hyoid bone (arrow in c) and inferiorly to the skin ostium near the pyramidal lobe of the thyroid (arrow in d). (e) Photograph of the surgical specimen reveals entire length of the fistulous tract.
|
|
View larger version (107K):
[in a new window]
|
Figure 2c. Persistent thyroglossal duct sinus tract in a 5-year-old boy who had undergone two partial resections for a thyroglossal duct cyst in the preceding 9 months. (a) Photograph of the lower neck shows a fistulous ostium with a transverse surgical scar on both sides. (b) CT scan obtained after ethiodized oil was injected into the fistula shows focal collection of the contrast agent in the region of the foramen cecum (arrow). (c, d) CT scans obtained at lower levels show the contrast material–enhanced path of the thyroglossal duct along the anterior surface of the hyoid bone (arrow in c) and inferiorly to the skin ostium near the pyramidal lobe of the thyroid (arrow in d). (e) Photograph of the surgical specimen reveals entire length of the fistulous tract.
|
|
View larger version (96K):
[in a new window]
|
Figure 2d. Persistent thyroglossal duct sinus tract in a 5-year-old boy who had undergone two partial resections for a thyroglossal duct cyst in the preceding 9 months. (a) Photograph of the lower neck shows a fistulous ostium with a transverse surgical scar on both sides. (b) CT scan obtained after ethiodized oil was injected into the fistula shows focal collection of the contrast agent in the region of the foramen cecum (arrow). (c, d) CT scans obtained at lower levels show the contrast material–enhanced path of the thyroglossal duct along the anterior surface of the hyoid bone (arrow in c) and inferiorly to the skin ostium near the pyramidal lobe of the thyroid (arrow in d). (e) Photograph of the surgical specimen reveals entire length of the fistulous tract.
|
|
View larger version (103K):
[in a new window]
|
Figure 2e. Persistent thyroglossal duct sinus tract in a 5-year-old boy who had undergone two partial resections for a thyroglossal duct cyst in the preceding 9 months. (a) Photograph of the lower neck shows a fistulous ostium with a transverse surgical scar on both sides. (b) CT scan obtained after ethiodized oil was injected into the fistula shows focal collection of the contrast agent in the region of the foramen cecum (arrow). (c, d) CT scans obtained at lower levels show the contrast material–enhanced path of the thyroglossal duct along the anterior surface of the hyoid bone (arrow in c) and inferiorly to the skin ostium near the pyramidal lobe of the thyroid (arrow in d). (e) Photograph of the surgical specimen reveals entire length of the fistulous tract.
|
|
View larger version (124K):
[in a new window]
|
Figure 3. Photomicrograph (original magnification, x4; hematoxylin-eosin [H-E] stain) of a thyroglossal duct cyst specimen shows squamous epithelium (arrowheads). The cysts may also be lined with respiratory epithelium. Most (about 60%) of these lesions contain some remnant of thyroid tissue (arrows).
|
|
View larger version (118K):
[in a new window]
|
Figure 4a. Thyroglossal duct cyst in a 41-year-old man. (a, b) Axial contrast-enhanced CT scans show a cystic mass in the anterior midline of the neck just above (a) and at the level of (b) the hyoid bone. (c) Axial T1-weighted MR image at the thyrohyoid membrane level shows hyperintensity of the mass, a finding suggestive of proteinaceous content or hemorrhage.
|
|
View larger version (112K):
[in a new window]
|
Figure 4b. Thyroglossal duct cyst in a 41-year-old man. (a, b) Axial contrast-enhanced CT scans show a cystic mass in the anterior midline of the neck just above (a) and at the level of (b) the hyoid bone. (c) Axial T1-weighted MR image at the thyrohyoid membrane level shows hyperintensity of the mass, a finding suggestive of proteinaceous content or hemorrhage.
|
|
View larger version (122K):
[in a new window]
|
Figure 4c. Thyroglossal duct cyst in a 41-year-old man. (a, b) Axial contrast-enhanced CT scans show a cystic mass in the anterior midline of the neck just above (a) and at the level of (b) the hyoid bone. (c) Axial T1-weighted MR image at the thyrohyoid membrane level shows hyperintensity of the mass, a finding suggestive of proteinaceous content or hemorrhage.
|
|
View larger version (155K):
[in a new window]
|
Figure 5. Figures 5, 6. (5) Thyroglossal duct cyst in a 39-year-old man. Contrast-enhanced CT scan shows a hypoattenuated mass (m) in the right strap muscles. (Courtesy of the Department of Radiology, Neuroradiology Section, University of California at San Francisco.) (6) Thyroglossal duct cyst in a 71-year-old man with a 1-year history of progressive swelling on the left side of the neck. (a) Contrast-enhanced CT scan shows a large cystic mass arising from the left strap muscles. (b) Photograph of the cut specimen shows the smooth inner lining and roughened exterior surface of the cyst.
|
|
View larger version (123K):
[in a new window]
|
Figure 6a. Figures 5, 6. (5) Thyroglossal duct cyst in a 39-year-old man. Contrast-enhanced CT scan shows a hypoattenuated mass (m) in the right strap muscles. (Courtesy of the Department of Radiology, Neuroradiology Section, University of California at San Francisco.) (6) Thyroglossal duct cyst in a 71-year-old man with a 1-year history of progressive swelling on the left side of the neck. (a) Contrast-enhanced CT scan shows a large cystic mass arising from the left strap muscles. (b) Photograph of the cut specimen shows the smooth inner lining and roughened exterior surface of the cyst.
|
|
View larger version (107K):
[in a new window]
|
Figure 6b. Figures 5, 6. (5) Thyroglossal duct cyst in a 39-year-old man. Contrast-enhanced CT scan shows a hypoattenuated mass (m) in the right strap muscles. (Courtesy of the Department of Radiology, Neuroradiology Section, University of California at San Francisco.) (6) Thyroglossal duct cyst in a 71-year-old man with a 1-year history of progressive swelling on the left side of the neck. (a) Contrast-enhanced CT scan shows a large cystic mass arising from the left strap muscles. (b) Photograph of the cut specimen shows the smooth inner lining and roughened exterior surface of the cyst.
|
|
View larger version (50K):
[in a new window]
|
Figure 7. Branchial apparatus. Diagram illustrates the developing branchial apparatus. The branchial clefts (or grooves) are ectodermal lined, whereas the pharyngeal pouches are of endodermal origin. The branchial arches are mesodermal in nature. The second branchial arch begins to overgrow the third and fourth branchial arches to form the cervical sinus of His. In normal development, the sinus is obliterated when the second branchial arch merges with the epicardial ridge. (Reprinted, with permission, from reference 26.)
|
|
View larger version (34K):
[in a new window]
|
Figure 8. Second branchial cleft tract. Drawing shows the path of second branchial cleft anomalies, which can occur anywhere along a line from the supraclavicular region to the oropharyngeal mucosa. The path travels lateral to the common carotid artery, then heads medially between the external carotid (EC) and internal carotid (IC) arteries under the glossopharyngeal nerve (IX) and above the hypoglossal nerve (XII). If the tract continues further along this course, it will enter the parapharyngeal space and pierce the middle constrictor muscle before ending as an opening within the tonsillar fossa. (Reprinted, with permission, from reference 5.)
|
|
View larger version (169K):
[in a new window]
|
Figure 9. Photomicrograph (original magnification, x10; H-E stain) of a branchial cleft cyst specimen shows lining of stratified squamous epithelium (arrowheads). The cyst wall usually contains a diffuse or nodular lymphoid component, often with germinal centers (arrow). The absence of sinusoids and a subcapsular sinus distinguishes this from a lymph node.
|
|
View larger version (102K):
[in a new window]
|
Figure 10a. Second branchial cleft cyst in a 30-year-old woman with a 14-month history of a mass in the left side of the neck that was unresponsive to antibiotics and that enlarged somewhat the month before surgery. (a) Axial T1-weighted image shows a well-defined mass (m) along the anterior border of the left sternocleidomastoid muscle (arrowhead), lateral to the carotid space (white arrow), and posterior to the submandibular gland (black arrow)—the classic location for a second branchial cleft cyst. Increased signal intensity of the mass is due to either proteinaceous debris or prior hemorrhage. (b) Axial T2-weighted image reveals moderate to marked hypointensity of the mass (m), consistent with accumulation of proteinaceous debris or hemorrhage. (c) Coronal contrast-enhanced T1-weighted image with fat suppression shows mild rim enhancement of the mass (m). (d) Intraoperative photograph shows the mass and sternocleidomastoid muscle outlined in ink on the skin surface. (e) Photograph of the surgical specimen shows the well-circumscribed mass with mildly lobulated contours.
|
|
View larger version (104K):
[in a new window]
|
Figure 10b. Second branchial cleft cyst in a 30-year-old woman with a 14-month history of a mass in the left side of the neck that was unresponsive to antibiotics and that enlarged somewhat the month before surgery. (a) Axial T1-weighted image shows a well-defined mass (m) along the anterior border of the left sternocleidomastoid muscle (arrowhead), lateral to the carotid space (white arrow), and posterior to the submandibular gland (black arrow)—the classic location for a second branchial cleft cyst. Increased signal intensity of the mass is due to either proteinaceous debris or prior hemorrhage. (b) Axial T2-weighted image reveals moderate to marked hypointensity of the mass (m), consistent with accumulation of proteinaceous debris or hemorrhage. (c) Coronal contrast-enhanced T1-weighted image with fat suppression shows mild rim enhancement of the mass (m). (d) Intraoperative photograph shows the mass and sternocleidomastoid muscle outlined in ink on the skin surface. (e) Photograph of the surgical specimen shows the well-circumscribed mass with mildly lobulated contours.
|
|
View larger version (122K):
[in a new window]
|
Figure 10c. Second branchial cleft cyst in a 30-year-old woman with a 14-month history of a mass in the left side of the neck that was unresponsive to antibiotics and that enlarged somewhat the month before surgery. (a) Axial T1-weighted image shows a well-defined mass (m) along the anterior border of the left sternocleidomastoid muscle (arrowhead), lateral to the carotid space (white arrow), and posterior to the submandibular gland (black arrow)—the classic location for a second branchial cleft cyst. Increased signal intensity of the mass is due to either proteinaceous debris or prior hemorrhage. (b) Axial T2-weighted image reveals moderate to marked hypointensity of the mass (m), consistent with accumulation of proteinaceous debris or hemorrhage. (c) Coronal contrast-enhanced T1-weighted image with fat suppression shows mild rim enhancement of the mass (m). (d) Intraoperative photograph shows the mass and sternocleidomastoid muscle outlined in ink on the skin surface. (e) Photograph of the surgical specimen shows the well-circumscribed mass with mildly lobulated contours.
|
|
View larger version (114K):
[in a new window]
|
Figure 10d. Second branchial cleft cyst in a 30-year-old woman with a 14-month history of a mass in the left side of the neck that was unresponsive to antibiotics and that enlarged somewhat the month before surgery. (a) Axial T1-weighted image shows a well-defined mass (m) along the anterior border of the left sternocleidomastoid muscle (arrowhead), lateral to the carotid space (white arrow), and posterior to the submandibular gland (black arrow)—the classic location for a second branchial cleft cyst. Increased signal intensity of the mass is due to either proteinaceous debris or prior hemorrhage. (b) Axial T2-weighted image reveals moderate to marked hypointensity of the mass (m), consistent with accumulation of proteinaceous debris or hemorrhage. (c) Coronal contrast-enhanced T1-weighted image with fat suppression shows mild rim enhancement of the mass (m). (d) Intraoperative photograph shows the mass and sternocleidomastoid muscle outlined in ink on the skin surface. (e) Photograph of the surgical specimen shows the well-circumscribed mass with mildly lobulated contours.
|
|
View larger version (123K):
[in a new window]
|
Figure 10e. Second branchial cleft cyst in a 30-year-old woman with a 14-month history of a mass in the left side of the neck that was unresponsive to antibiotics and that enlarged somewhat the month before surgery. (a) Axial T1-weighted image shows a well-defined mass (m) along the anterior border of the left sternocleidomastoid muscle (arrowhead), lateral to the carotid space (white arrow), and posterior to the submandibular gland (black arrow)—the classic location for a second branchial cleft cyst. Increased signal intensity of the mass is due to either proteinaceous debris or prior hemorrhage. (b) Axial T2-weighted image reveals moderate to marked hypointensity of the mass (m), consistent with accumulation of proteinaceous debris or hemorrhage. (c) Coronal contrast-enhanced T1-weighted image with fat suppression shows mild rim enhancement of the mass (m). (d) Intraoperative photograph shows the mass and sternocleidomastoid muscle outlined in ink on the skin surface. (e) Photograph of the surgical specimen shows the well-circumscribed mass with mildly lobulated contours.
|
|
View larger version (134K):
[in a new window]
|
Figure 11a. Figures 11, 12. (11) Second branchial cleft cyst in an 11-year-old boy with a mass in the right side of the neck and a history of recurrent inflammation. (a) Axial gadolinium-enhanced T1-weighted MR image shows a hypointense mass in the right side of the neck in the classic location for a second branchial cleft cyst. Irregular inner border of the mass suggests an associated inflammatory process. (b) Coronal T1-weighted MR image shows the mass at the inferior margin of the right parotid gland and lateral to carotid vessels. (c) Photograph of the resected specimen shows the thick capsule of the cystic lesion filled with keratinaceous debris. (12) Second branchial cleft cyst in a 29-year-old woman with a 1-month history of dysphagia, otalgia of the right ear, and swelling of the right side of the neck. Contrast-enhanced CT scan shows a well-defined, right-sided neck mass (m) deep to the carotid space and with medial extension toward the oropharynx.
|
|
View larger version (128K):
[in a new window]
|
Figure 11b. Figures 11, 12. (11) Second branchial cleft cyst in an 11-year-old boy with a mass in the right side of the neck and a history of recurrent inflammation. (a) Axial gadolinium-enhanced T1-weighted MR image shows a hypointense mass in the right side of the neck in the classic location for a second branchial cleft cyst. Irregular inner border of the mass suggests an associated inflammatory process. (b) Coronal T1-weighted MR image shows the mass at the inferior margin of the right parotid gland and lateral to carotid vessels. (c) Photograph of the resected specimen shows the thick capsule of the cystic lesion filled with keratinaceous debris. (12) Second branchial cleft cyst in a 29-year-old woman with a 1-month history of dysphagia, otalgia of the right ear, and swelling of the right side of the neck. Contrast-enhanced CT scan shows a well-defined, right-sided neck mass (m) deep to the carotid space and with medial extension toward the oropharynx.
|
|
View larger version (99K):
[in a new window]
|
Figure 11c. Figures 11, 12. (11) Second branchial cleft cyst in an 11-year-old boy with a mass in the right side of the neck and a history of recurrent inflammation. (a) Axial gadolinium-enhanced T1-weighted MR image shows a hypointense mass in the right side of the neck in the classic location for a second branchial cleft cyst. Irregular inner border of the mass suggests an associated inflammatory process. (b) Coronal T1-weighted MR image shows the mass at the inferior margin of the right parotid gland and lateral to carotid vessels. (c) Photograph of the resected specimen shows the thick capsule of the cystic lesion filled with keratinaceous debris. (12) Second branchial cleft cyst in a 29-year-old woman with a 1-month history of dysphagia, otalgia of the right ear, and swelling of the right side of the neck. Contrast-enhanced CT scan shows a well-defined, right-sided neck mass (m) deep to the carotid space and with medial extension toward the oropharynx.
|
|
View larger version (106K):
[in a new window]
|
Figure 12. Figures 11, 12. (11) Second branchial cleft cyst in an 11-year-old boy with a mass in the right side of the neck and a history of recurrent inflammation. (a) Axial gadolinium-enhanced T1-weighted MR image shows a hypointense mass in the right side of the neck in the classic location for a second branchial cleft cyst. Irregular inner border of the mass suggests an associated inflammatory process. (b) Coronal T1-weighted MR image shows the mass at the inferior margin of the right parotid gland and lateral to carotid vessels. (c) Photograph of the resected specimen shows the thick capsule of the cystic lesion filled with keratinaceous debris. (12) Second branchial cleft cyst in a 29-year-old woman with a 1-month history of dysphagia, otalgia of the right ear, and swelling of the right side of the neck. Contrast-enhanced CT scan shows a well-defined, right-sided neck mass (m) deep to the carotid space and with medial extension toward the oropharynx.
|
|
View larger version (113K):
[in a new window]
|
Figure 13. Photomicrograph (original magnification, x1; H-E stain) of a cystic hygroma specimen shows multiple endothelium-lined vascular spaces. Several of the larger spaces (S) are indicated. The stroma includes fibrous tissue, adipose tissue, and aggregates of lymphoid cells (arrows).
|
|
View larger version (103K):
[in a new window]
|
Figure 14. Cystic hygroma. Intrauterine sonogram, obtained at 14 weeks gestation to evaluate vaginal bleeding, shows a large, multiseptated, anechoic mass (h) of the posterior neck.
|
|
View larger version (106K):
[in a new window]
|
Figure 15. Figures 15, 16. (15) Cystic hygroma in a 28-year-old man with a 4-week history of painless swelling of the left side of the neck unresponsive to antibiotics. Fine-needle aspiration yielded serous fluid. Contrast-enhanced CT scan shows a hypoattenuated mass (h) within the posterior cervical space deep to the sternocleidomastoid muscle. At surgery, the mass was adherent to the internal jugular vein. (Courtesy of the Department of Radiology, Naval Medical Center, San Diego, Calif.) (16) Cystic hygroma in a newborn boy. (a) Photograph shows a large bilobulated mass extending from the neck into the chest wall, axilla, and lower face. (b) Sagittal CT scan shows erosion of the mandible and invasion of the oral cavity. Multiple septa are seen.
|
|
View larger version (84K):
[in a new window]
|
Figure 16a. Figures 15, 16. (15) Cystic hygroma in a 28-year-old man with a 4-week history of painless swelling of the left side of the neck unresponsive to antibiotics. Fine-needle aspiration yielded serous fluid. Contrast-enhanced CT scan shows a hypoattenuated mass (h) within the posterior cervical space deep to the sternocleidomastoid muscle. At surgery, the mass was adherent to the internal jugular vein. (Courtesy of the Department of Radiology, Naval Medical Center, San Diego, Calif.) (16) Cystic hygroma in a newborn boy. (a) Photograph shows a large bilobulated mass extending from the neck into the chest wall, axilla, and lower face. (b) Sagittal CT scan shows erosion of the mandible and invasion of the oral cavity. Multiple septa are seen.
|
|
View larger version (126K):
[in a new window]
|
Figure 16b. Figures 15, 16. (15) Cystic hygroma in a 28-year-old man with a 4-week history of painless swelling of the left side of the neck unresponsive to antibiotics. Fine-needle aspiration yielded serous fluid. Contrast-enhanced CT scan shows a hypoattenuated mass (h) within the posterior cervical space deep to the sternocleidomastoid muscle. At surgery, the mass was adherent to the internal jugular vein. (Courtesy of the Department of Radiology, Naval Medical Center, San Diego, Calif.) (16) Cystic hygroma in a newborn boy. (a) Photograph shows a large bilobulated mass extending from the neck into the chest wall, axilla, and lower face. (b) Sagittal CT scan shows erosion of the mandible and invasion of the oral cavity. Multiple septa are seen.
|
|
View larger version (118K):
[in a new window]
|
Figure 17a. Figures 17–19. (17) Cystic hygroma in a 20-month-old girl with swelling under the right jaw and neck noted by the mother. (a) Contrast-enhanced CT scan shows a large right-sided neck mass with fluid-fluid levels (arrows) indicative of recent hemorrhage. (b) Axial T1-weighted image shows heterogeneous signal intensity within the mass (m), which fills the right parotid space and portions of the mandibular space. Areas of hyperintensity correspond to regions of hemorrhage. (c) Coronal T1-weighted image shows extension of the mass into submandibular and sublingual spaces. (d) Photograph of the specimen shows the cystic lobules (arrows) of the multiloculated mass; cut surface (arrowheads) of a lobule reveals hemorrhage. (18) Cystic hygroma. Axial T1-weighted image shows a well-defined mass (m) within the right posterior cervical space that displaces the adjacent sternocleidomastoid muscle. (19) Cystic hygroma in a 36-year-old woman with a left-sided neck mass that enlarged during viral upper respiratory infections. Coronal T1-weighted image shows a large hypointense mass in the left side of the neck extending from the submandibular space to the thoracic inlet. Multiple septa (arrows) cross the lesion.
|
|
View larger version (118K):
[in a new window]
|
Figure 17b. Figures 17–19. (17) Cystic hygroma in a 20-month-old girl with swelling under the right jaw and neck noted by the mother. (a) Contrast-enhanced CT scan shows a large right-sided neck mass with fluid-fluid levels (arrows) indicative of recent hemorrhage. (b) Axial T1-weighted image shows heterogeneous signal intensity within the mass (m), which fills the right parotid space and portions of the mandibular space. Areas of hyperintensity correspond to regions of hemorrhage. (c) Coronal T1-weighted image shows extension of the mass into submandibular and sublingual spaces. (d) Photograph of the specimen shows the cystic lobules (arrows) of the multiloculated mass; cut surface (arrowheads) of a lobule reveals hemorrhage. (18) Cystic hygroma. Axial T1-weighted image shows a well-defined mass (m) within the right posterior cervical space that displaces the adjacent sternocleidomastoid muscle. (19) Cystic hygroma in a 36-year-old woman with a left-sided neck mass that enlarged during viral upper respiratory infections. Coronal T1-weighted image shows a large hypointense mass in the left side of the neck extending from the submandibular space to the thoracic inlet. Multiple septa (arrows) cross the lesion.
|
|
View larger version (146K):
[in a new window]
|
Figure 17c. Figures 17–19. (17) Cystic hygroma in a 20-month-old girl with swelling under the right jaw and neck noted by the mother. (a) Contrast-enhanced CT scan shows a large right-sided neck mass with fluid-fluid levels (arrows) indicative of recent hemorrhage. (b) Axial T1-weighted image shows heterogeneous signal intensity within the mass (m), which fills the right parotid space and portions of the mandibular space. Areas of hyperintensity correspond to regions of hemorrhage. (c) Coronal T1-weighted image shows extension of the mass into submandibular and sublingual spaces. (d) Photograph of the specimen shows the cystic lobules (arrows) of the multiloculated mass; cut surface (arrowheads) of a lobule reveals hemorrhage. (18) Cystic hygroma. Axial T1-weighted image shows a well-defined mass (m) within the right posterior cervical space that displaces the adjacent sternocleidomastoid muscle. (19) Cystic hygroma in a 36-year-old woman with a left-sided neck mass that enlarged during viral upper respiratory infections. Coronal T1-weighted image shows a large hypointense mass in the left side of the neck extending from the submandibular space to the thoracic inlet. Multiple septa (arrows) cross the lesion.
|
|
View larger version (110K):
[in a new window]
|
Figure 17d. Figures 17–19. (17) Cystic hygroma in a 20-month-old girl with swelling under the right jaw and neck noted by the mother. (a) Contrast-enhanced CT scan shows a large right-sided neck mass with fluid-fluid levels (arrows) indicative of recent hemorrhage. (b) Axial T1-weighted image shows heterogeneous signal intensity within the mass (m), which fills the right parotid space and portions of the mandibular space. Areas of hyperintensity correspond to regions of hemorrhage. (c) Coronal T1-weighted image shows extension of the mass into submandibular and sublingual spaces. (d) Photograph of the specimen shows the cystic lobules (arrows) of the multiloculated mass; cut surface (arrowheads) of a lobule reveals hemorrhage. (18) Cystic hygroma. Axial T1-weighted image shows a well-defined mass (m) within the right posterior cervical space that displaces the adjacent sternocleidomastoid muscle. (19) Cystic hygroma in a 36-year-old woman with a left-sided neck mass that enlarged during viral upper respiratory infections. Coronal T1-weighted image shows a large hypointense mass in the left side of the neck extending from the submandibular space to the thoracic inlet. Multiple septa (arrows) cross the lesion.
|
|
View larger version (90K):
[in a new window]
|
Figure 18. Figures 17–19. (17) Cystic hygroma in a 20-month-old girl with swelling under the right jaw and neck noted by the mother. (a) Contrast-enhanced CT scan shows a large right-sided neck mass with fluid-fluid levels (arrows) indicative of recent hemorrhage. (b) Axial T1-weighted image shows heterogeneous signal intensity within the mass (m), which fills the right parotid space and portions of the mandibular space. Areas of hyperintensity correspond to regions of hemorrhage. (c) Coronal T1-weighted image shows extension of the mass into submandibular and sublingual spaces. (d) Photograph of the specimen shows the cystic lobules (arrows) of the multiloculated mass; cut surface (arrowheads) of a lobule reveals hemorrhage. (18) Cystic hygroma. Axial T1-weighted image shows a well-defined mass (m) within the right posterior cervical space that displaces the adjacent sternocleidomastoid muscle. (19) Cystic hygroma in a 36-year-old woman with a left-sided neck mass that enlarged during viral upper respiratory infections. Coronal T1-weighted image shows a large hypointense mass in the left side of the neck extending from the submandibular space to the thoracic inlet. Multiple septa (arrows) cross the lesion.
|
|
View larger version (140K):
[in a new window]
|
Figure 19. Figures 17–19. (17) Cystic hygroma in a 20-month-old girl with swelling under the right jaw and neck noted by the mother. (a) Contrast-enhanced CT scan shows a large right-sided neck mass with fluid-fluid levels (arrows) indicative of recent hemorrhage. (b) Axial T1-weighted image shows heterogeneous signal intensity within the mass (m), which fills the right parotid space and portions of the mandibular space. Areas of hyperintensity correspond to regions of hemorrhage. (c) Coronal T1-weighted image shows extension of the mass into submandibular and sublingual spaces. (d) Photograph of the specimen shows the cystic lobules (arrows) of the multiloculated mass; cut surface (arrowheads) of a lobule reveals hemorrhage. (18) Cystic hygroma. Axial T1-weighted image shows a well-defined mass (m) within the right posterior cervical space that displaces the adjacent sternocleidomastoid muscle. (19) Cystic hygroma in a 36-year-old woman with a left-sided neck mass that enlarged during viral upper respiratory infections. Coronal T1-weighted image shows a large hypointense mass in the left side of the neck extending from the submandibular space to the thoracic inlet. Multiple septa (arrows) cross the lesion.
|
|
View larger version (25K):
[in a new window]
|
Figure 20a. Location of floor-of-mouth lesions with respect to the mylohyoid muscle. (Reprinted, with permission, from reference 25.) (a) Diagram illustrates how a mass above the mylohyoid muscle can be resected with an intraoral approach. (b) Diagram illustrates how resection of a mass below the mylohyoid muscle requires an external neck approach, usually through a transverse incision.
|
|
View larger version (24K):
[in a new window]
|
Figure 20b. Location of floor-of-mouth lesions with respect to the mylohyoid muscle. (Reprinted, with permission, from reference 25.) (a) Diagram illustrates how a mass above the mylohyoid muscle can be resected with an intraoral approach. (b) Diagram illustrates how resection of a mass below the mylohyoid muscle requires an external neck approach, usually through a transverse incision.
|
|
View larger version (140K):
[in a new window]
|
Figure 21. Photomicrograph (original magnification, x1; H-E stain) of a dermoid cyst specimen shows epidermal appendages, such as the pilosebaceous units (arrows), in association with an epidermal lining (arrowheads).
|
|
View larger version (150K):
[in a new window]
|
Figure 22. Photomicrograph (original magnification, x1; H-E stain) of an epidermal inclusion cyst specimen shows its lining of stratified squamous epithelium (arrowheads). The cyst is filled with laminated keratinaceous material (k).
|
|
View larger version (108K):
[in a new window]
|
Figure 23a. Dermoid cyst in a 35-year-old woman with a 1-week history of neck swelling. (a) Axial contrast-enhanced CT scan shows a well-defined mass in the submandibular-submental region with multiple discrete foci of hypoattenuation in the nondependent portion of the cyst. (b) Coronal CT scan shows the mass inferior to the mylohyoid muscle (arrowheads). (c) Photograph of the opened cyst shows multiple spherical masses floating in fluid contents. Scale is in centimeters.
|
|
View larger version (115K):
[in a new window]
|
Figure 23b. Dermoid cyst in a 35-year-old woman with a 1-week history of neck swelling. (a) Axial contrast-enhanced CT scan shows a well-defined mass in the submandibular-submental region with multiple discrete foci of hypoattenuation in the nondependent portion of the cyst. (b) Coronal CT scan shows the mass inferior to the mylohyoid muscle (arrowheads). (c) Photograph of the opened cyst shows multiple spherical masses floating in fluid contents. Scale is in centimeters.
|
|
View larger version (116K):
[in a new window]
|
Figure 23c. Dermoid cyst in a 35-year-old woman with a 1-week history of neck swelling. (a) Axial contrast-enhanced CT scan shows a well-defined mass in the submandibular-submental region with multiple discrete foci of hypoattenuation in the nondependent portion of the cyst. (b) Coronal CT scan shows the mass inferior to the mylohyoid muscle (arrowheads). (c) Photograph of the opened cyst shows multiple spherical masses floating in fluid contents. Scale is in centimeters.
|
|
View larger version (127K):
[in a new window]
|
Figure 24a. Dermoid cyst. (a) Axial contrast-enhanced CT scan shows a well-defined mass in the submandibular space with a sack-of-marbles appearance. (b) US scan shows the mass with multiple echogenic foci and shadowing. (c) Coronal T1-weighted image shows the discrete intracystic foci, which have moderate hyperintensity. The mass displaces the left submandibular gland (g) inferiorly.
|
|
View larger version (125K):
[in a new window]
|
Figure 24b. Dermoid cyst. (a) Axial contrast-enhanced CT scan shows a well-defined mass in the submandibular space with a sack-of-marbles appearance. (b) US scan shows the mass with multiple echogenic foci and shadowing. (c) Coronal T1-weighted image shows the discrete intracystic foci, which have moderate hyperintensity. The mass displaces the left submandibular gland (g) inferiorly.
|
|
View larger version (106K):
[in a new window]
|
Figure 24c. Dermoid cyst. (a) Axial contrast-enhanced CT scan shows a well-defined mass in the submandibular space with a sack-of-marbles appearance. (b) US scan shows the mass with multiple echogenic foci and shadowing. (c) Coronal T1-weighted image shows the discrete intracystic foci, which have moderate hyperintensity. The mass displaces the left submandibular gland (g) inferiorly.
|
|
View larger version (141K):
[in a new window]
|
Figure 25a. Epidermoid inclusion cyst in a 30-year-old woman. (a) Axial contrast-enhanced CT scan shows an encapsulated, hypoattenuated mass with partial adipose content. The coalescence of the lipid material produces a sack-of-marbles appearance. (b) Photograph of the cut specimen shows the mass is filled with homogeneous, sebaceous material.
|
|
View larger version (104K):
[in a new window]
|
Figure 25b. Epidermoid inclusion cyst in a 30-year-old woman. (a) Axial contrast-enhanced CT scan shows an encapsulated, hypoattenuated mass with partial adipose content. The coalescence of the lipid material produces a sack-of-marbles appearance. (b) Photograph of the cut specimen shows the mass is filled with homogeneous, sebaceous material.
|
|
View larger version (37K):
[in a new window]
|
Figure 26. Pathway of the thymopharyngeal duct. Drawing shows a frontal view of the neck. The thymus and parathyroid glands arise from the third and fourth pharyngeal pouches. The thymopharyngeal duct arises from the developing pyriform sinus and descends into the mediastinum, traveling lateral to the thyroid gland. Cervical thymic cysts, among other congenital anomalies, arise along this tract. (Reprinted, with permission, from reference 26.)
|
|
View larger version (152K):
[in a new window]
|
Figure 27a. (a) Photomicrograph (original magnification, x10; H-E stain) of a thymic cyst specimen shows its squamous epithelial lining (arrowheads). (b) Photomicrograph (original magnification, x10; H-E stain) of a thymic cyst specimen shows thymic tissue in the cyst wall. These lobular aggregates of lymphoid tissue contain Hassall corpuscles (small, round, squamous islands) (arrows). Two large areas of cystic degeneration (c) are indicated.
|
|
View larger version (173K):
[in a new window]
|
Figure 27b. (a) Photomicrograph (original magnification, x10; H-E stain) of a thymic cyst specimen shows its squamous epithelial lining (arrowheads). (b) Photomicrograph (original magnification, x10; H-E stain) of a thymic cyst specimen shows thymic tissue in the cyst wall. These lobular aggregates of lymphoid tissue contain Hassall corpuscles (small, round, squamous islands) (arrows). Two large areas of cystic degeneration (c) are indicated.
|
|
View larger version (109K):
[in a new window]
|
Figure 28a. Thymic cyst in a 35-week gestation male infant in whom a left-sided neck mass was noted incidentally at discharge physical examination. During radiologic evaluation, the patient developed stridor secondary to enlargement of the mass. (a) Unenhanced CT scan obtained at the level of the mandible shows the largest width of the predominantly hypoattenuated mass. The airway is displaced and compressed by the retropharyngeal mass. (b) Unenhanced CT scan obtained at the thoracic inlet level shows the inferior extent of the mass into the mediastinum with expansion of the left hemithorax.
|
|
View larger version (112K):
[in a new window]
|
Figure 28b. Thymic cyst in a 35-week gestation male infant in whom a left-sided neck mass was noted incidentally at discharge physical examination. During radiologic evaluation, the patient developed stridor secondary to enlargement of the mass. (a) Unenhanced CT scan obtained at the level of the mandible shows the largest width of the predominantly hypoattenuated mass. The airway is displaced and compressed by the retropharyngeal mass. (b) Unenhanced CT scan obtained at the thoracic inlet level shows the inferior extent of the mass into the mediastinum with expansion of the left hemithorax.
|
|
View larger version (50K):
[in a new window]
|
Figure 29. Drawing illustrates the three types of laryngocele. Internal laryngoceles are within the larynx itself and do not cross the thyrohyoid membrane. External laryngoceles penetrate the thyrohyoid membrane at the neurovascular bundle. The segment confined by the membrane is of normal size and connects normally with the laryngeal ventricle, whereas the portion outside the membrane is dilated. Mixed laryngoceles are dilated in both segments. (Reprinted, with permission, from reference 5.)
|
|
View larger version (177K):
[in a new window]
|
Figure 30. Photomicrograph (original magnification, x10; H-E stain) of a laryngocele specimen shows respiratory epithelium (arrowheads) lining a cystic dilatation of the laryngeal saccule.
|
|
View larger version (113K):
[in a new window]
|
Figure 31a. Congenital laryngocele in a 2-day-old infant boy. (a) Lateral neck radiograph shows both a large retrotracheal soft-tissue mass and an air-containing mass anterior to the airway. (b) Axial CT scan shows a large retro- and paratracheal cystic lesion displacing and narrowing the airway lumen. The presence of an air-fluid level within the mass suggests communication with the airway.
|
|
View larger version (128K):
[in a new window]
|
Figure 31b. Congenital laryngocele in a 2-day-old infant boy. (a) Lateral neck radiograph shows both a large retrotracheal soft-tissue mass and an air-containing mass anterior to the airway. (b) Axial CT scan shows a large retro- and paratracheal cystic lesion displacing and narrowing the airway lumen. The presence of an air-fluid level within the mass suggests communication with the airway.
|
|
Copyright © 1999 by the Radiological Society of North America.
