Brachial Cleft Cyst

Preliminary Diagnosis: Brachial cleft cyst

I. What imaging technique is first-line for this diagnosis?

CT scan with IV contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of brachial cleft cyst.

Advantages

• Can delineate secondary complications such as infection and necrosis of a branchial cleft cyst when IV contrast is administered

• May be performed more expeditiously than MRI, requiring less patient cooperation and is associated with less patient motion artifact

• May better localize and define the anatomy of a branchial cleft cyst in relation to surrounding osseous and vascular structures

Disadvantages

• Exposes a patient to a large amount of ionizing radiation

• Exposes the patient to IV contrast and requires adequate renal function (creatinine)

III. What are the contraindications for the first-line imaging technique?

Contraindicated in pregnant patients, especially within the first two trimesters,

IV. What alternative imaging techniques are available?

• MRI

• Ultrasound evaluation of the neck

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of brachial cleft cyst.

MRI

Advantages

• Does not expose the patient to ionizing radiation.

Disadvantages

• Expensive

• Time-consuming imaging modality

• Requires significant patient cooperation to limit motion artifact

• IV contrast requires that the patient have good renal function with a GFR >60. Administration of contrast is decided on a case-by-case basis with GFR <60 and >30.

• Has poor visualization of the adjacent osseous structures

Ultrasound

Advantages

• Relatively inexpensive

• Portable imaging modality

• Does not expose the patinet to ionizing radiation

Disadvantages

• Sonographic imaging may be limited in obese patients.

• There is limited evaluation in detaiiling enhancing structures such as infected branchial cleft cysts and secondary abscesses.

• Ultrasound is less adept in detailing anatomy surrounding branchial cleft cysts compared with MRI and CT.

VI. What are the contraindications for the alternative imaging techniques?

MRI

• MRI is contraindicated in patients with non-MR-compatible hardware.

• No significant contraindications to ultrasound imaging exist.