QuestionSBA
QuestionChoice
A very important consideration in any neck swelling but in this case is highly unlikely to be malignant. The most likely malignant cause of lymphadenopathy in a 12-year-old would be acute lymphoblastic leukaemia (ALL). This is not the case here as the patient is otherwise asymptomatic and, most importantly, blood tests are normal. Furthermore, fine needle aspiration reveals acellular fluid with cholesterol crystals which would not be found in a malignant node.
10000315
e
Malignancy
QuestionChoice
Branchial cleft cysts are common developmental defects of the branchial arches (most commonly the second branchial arch). They present in late childhood/adolescence and early adulthood and characteristically contain acellular fluid with cholesterol crystals.
10000311
a
Branchial cleft cyst
QuestionChoice
Another important "neck lump" differential, cervical lymphadenopathy is an important diagnosis to consider but this is not the case here. Cervical lymphadenopathy is characteristically firm and rubbery whereas this swelling is soft and fluctuant. Furthermore, an enlarged lymph node would not be acellular on fine needle aspiration.
10000314
d
Cervical lymphadenopathy
QuestionChoice
A cystic hygroma is a type of lymphangioma that forms in children. This example is unlikely to be a cystic hygroma as these masses typically present in the first 2 years of life. Additionally, although they can manifest anywhere on the body, the posterior triangle (i.e. posterior to the sternocleidomastoid muscle) is the most common location, whereas this mass is located anterior to the SCM muscle.
10000313
c
Cystic hygroma
QuestionChoice
Although an important differential, this case is not a thyroglossal cyst. Thyroglossal cysts classically move on swallowing whereas this mass does not. Furthermore, thyroglossal cysts are typically midline masses whereas this mass lies laterally, on the left side.
10000312
b
Thyroglossal cyst
Concept
Chapter
2693
3740
Branchial cyst
Topic
139
Ear, Nose, and Throat
12609
A 12-year-old female presents to the ENT clinic with a unilateral, left-sided neck swelling that has been slowly increasing in size over the past 10 days. On examination, there is a left-sided neck swelling lying anterior to the sternocleidomastoid muscle that does not move on swallowing. On palpation, you identify a 4cm well-circumscribed, soft, non-tender, smooth, and fluctuant swelling. Fine needle aspiration reveals acellular fluid with cholesterol crystals. Blood results are normal.

Which of the following is the most likely diagnosis?
a