Imaging
Brachial Cleft Cyst
- Preliminary Diagnosis: Brachial cleft cyst
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosis of brachial cleft cyst.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of brachial cleft cyst.
- VI. What are the contraindications for the alternative imaging techniques?
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.
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