Lymphadenitis (Differential Diagnosis Second Branchial Cyst)

Figure tuha_21a_n.jpg to tuha_21c_n.jpg: A frequent differential diagnosis of the second branchial cyst or sinus are lymphadenopathies of inflammatory or - less frequently - neoplastic origin, which are observed from infancy to adolescence. Depending on the stage and the type of lymphadenitis, the differentiation may be easier or more difficult. Figure tuha_21a_n.jpg: In this 1.7-year-old child the diffuse swelling without any obvious inflammatory signs (except for a sligth redness) reminds of a cystic lymphangioma or of a cranially situated second branchial cyst. In fact, the diagnosis is a left phlegmonous lymphadenitis at the angle of the lower jaw. $$tuha_16??nr=2££See figure 1 to compare§§ $$tuha_10??nr=2££and figure 2 to compare§§ . Figure tuha_21b_n.jpg: In case of a beginning abscess such as shown in this 6-year-old girl with angular lymphadenitis the clinical diagnosis is less difficult. Depending on the site of the involved lymph node and extension of the inflammatory swelling, an infected second branchial cyst has to be considered, too, or - rarely - an infected first branchial anomaly located below the auricle and within the auditory channel. Figure tuha_21c_n.jpg: This subacute or chronic inflammation in this 12-year-old girl with a specific lymphadenitis of the neck reminds of an inflammatory complication of a second branchial cyst. Nevertheless, the mass is a little too medial and too cranial from the sternocleidomastoid muscle (visible at the left lower edge) to be a second branchial cyst. The local findings are similar in toxoplasmosis and in Pfeiffer's mononucleosis. Chronic fistulous lymphadenitis caused by an atypical mycobacterium or by a viral scratch disease are also similar to a second branchial anomaly. A distinctive feature of lymphadenitis in childhood is the preferred submandibular or jugulodigastric site which is well recognizable if there are no diffuse soft tissue changes. In case of neoplastic jugulodigastric lymphoma (e.g. in Hodgkin disease in the second decade of life) the differentiation from a second branchial cyst may be difficult.