Imaging

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.

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