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Year : 2020  |  Volume : 8  |  Issue : 1  |  Page : 21-22

Bilateral second branchial cleft anomaly: Diagnosed on computed tomographic fistulography

1 Department of Radiology, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
2 Department of Cardiology, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India

Date of Submission01-Feb-2020
Date of Decision24-Feb-2020
Date of Acceptance02-Mar-2020
Date of Web Publication2-Jul-2020

Correspondence Address:
Madhurima Sharma
Department of Radiology, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda - 176 001, Himachal Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jomr.jomr_1_20

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How to cite this article:
Sharma M, Sood D, Chauhan IS, Thakur D, Dev M. Bilateral second branchial cleft anomaly: Diagnosed on computed tomographic fistulography. J Oral Maxillofac Radiol 2020;8:21-2

How to cite this URL:
Sharma M, Sood D, Chauhan IS, Thakur D, Dev M. Bilateral second branchial cleft anomaly: Diagnosed on computed tomographic fistulography. J Oral Maxillofac Radiol [serial online] 2020 [cited 2023 Mar 24];8:21-2. Available from: https://www.joomr.org/text.asp?2020/8/1/21/288830

A 6-year-old male patient presented with external discharge from skin openings in the neck on both sides of midline since birth. On local examination, external pitting was seen in the bilateral anterior cervical spaces, along the anterior aspect of sternocleidomastoid muscle [Figure 1]. Computed tomographic (CT) fistulography was performed on a 16 slice CT scanner (Brilliance CT, Philips, The Netherlands). Bilateral external openings were cannulated using a 20G needle followed by instillation of water-soluble, iodinated, nonionic contrast medium (iohexol, 300 mg/mL), using a 5 cc syringe. Intravenous iodinated contrast was also given during the study. CT fistulography showed opacification of a linear tract on the right side extending superiorly from external opening [white arrow in [Figure 2]]. The tract ran posterior to the submandibular gland and anterior to the carotid vessels and ended in the paraphrayngeal fat just above the hyoid bone [Figure 2] and [Figure 3]. No evidence of communication with pharyngeal mucosal space was seen. On the left side, pooling of contrast was seen in a small collection just deep to external opening [curved arrow in Figure 2]. A linear, unopacified, hypodense tract was also seen on the left side extending superiorly from the collection, running parallel to the tract on the right side [blue arrow in Figure 2]. Based upon these findings, a diagnosis of bilateral second branchial cleft anomaly was made (branchial sinus).
Figure 1: Clinical photograph showing external pitting of skin bilaterally (black arrow) just anterior to the sternocleidomastoid muscle

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Figure 2: (a-d) Axial contrast enhanced computed tomographic sections in caudocranial direction showing the course of the sinus tract bilaterally. Tract on the right side was well-opacified with contrast and extended from external opening to just superior to hyoid bone (white arrow). On the left side, a small collection was seen beneath the skin surface (curved arrow in a) with unopacified hypodense tract extending superiorly from it (blue arrow)

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Figure 3: (a and b) Sagittal and coronal maximum intensity projection images showing the opacified sinus tract on the right side (white arrow)

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Branchial arch anomalies are common congenital head-and-neck lesions in children and may present as cyst, sinus, fistula, or cartilaginous remnant. Second branchial cleft anomalies are the most common. They may occur anywhere along the course of the second branchial arch tract which extends from the skin in supraclavicular fossa, between internal and external carotid arteries till pharynx at the level of tonsillar fossa.[1],[2] Radiological examination of the branchial cleft anomalies is essential for accurate classification and management. Conventional fluoroscopic fistulography is commonly used for imaging evaluation of branchial cleft anomalies. However, CT fistulography offers better delineation of tract due to its multiplanar capabilities and also depicts the relation of tract to the surrounding structures.[3] Further, the cross-sectional imaging can demonstrate the unopacified portion of the tract in rare cases (as in this case).

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Waldhausen JH. Branchial cleft and arch anomalies in children. Semin Pediatr Surg 2006;15:64-9.  Back to cited text no. 1
Adams A, Mankad K, Offiah C, Childs L. Branchial cleft anomalies: A pictorial review of embryological development and spectrum of imaging findings. Insights Imaging 2016;7:69-76.  Back to cited text no. 2
Ryu CW, Lee JH, Lee HK, Lee DH, Choi CG, Kim SJ. Clinical usefulness of multidetector CT fistulography of branchial cleft fistula. Clin Imaging 2006;30:339-42.  Back to cited text no. 3


  [Figure 1], [Figure 2], [Figure 3]


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