A 35-year-old male presents with a painless, fluctuant swelling at the angle of the mandible. On aspiration, the fluid is watery and contains cholesterol crystals. What is the most likely diagnosis?
- A Lymph node abscess
- B Branchial cleft cyst (second branchial cleft cyst) ✓
- C Cystic hygroma
- D Dermoid cyst
Explanation
A second branchial cleft cyst is the most common branchial anomaly and classically presents as a painless, fluctuant swelling at the anterior border of the sternocleidomastoid at the junction of the upper and middle thirds. The fluid contains cholesterol crystals and is typically watery. It arises from incomplete obliteration of the cervical sinus (fusion of second through fifth branchial arches). Lymph node abscess is painful and tender; cystic hygroma presents at birth in the posterior triangle with brilliantly transilluminable fluid; dermoid cysts have sebaceous content.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.