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Anterior neck mass that appeared after a common cold

Published:September 01, 2020DOI:https://doi.org/10.1016/j.ejim.2020.06.030

      1. Introduction

      A 62-year-old man experienced a common cold for 7 days. He presented to the clinic with a 2-day history of anterior neck pain and swelling. His body temperature was 37.4°C, and a soft, well-defined mass was palpated in the midline near the hyoid bone (Fig. 1A). Slight erythema and tenderness were noted at the same site. A contrast-enhanced neck computed tomography (CT) was performed (Fig. 1B).
      Fig 1
      Fig. 1(A) A soft, well-defined midline neck mass near the hyoid bone. (B) Contrast-enhanced neck computed tomography showing a cystic lesion surrounded by a thin, contrast-enhanced wall of approximately 35 mm in diameter, located slightly left of the lower jaw midline, superior and anterior to the hyoid bone.
      What is the diagnosis?

      2. Diagnosis

      Thyroglossal duct cyst

      3. Discussion

      Thyroglossal duct cysts are congenital cysts derived from the residual tissue of the thyroglossal duct [
      • Thompson L.D.
      • Herrera H.B.
      • Lau S.K.
      A clinicopathologic series of 685 thyroglossal duct remnant cysts.
      ]. They are the most common cause of midline neck masses (52%) [
      • Knight P.J.
      • Hamoudi A.B.
      • Vassy L.E.
      The diagnosis and treatment of midline neck masses in children.
      ], with an incidence rate of 2.2 cases per 100,000 population per year [
      • Thompson L.D.
      • Herrera H.B.
      • Lau S.K.
      A clinicopathologic series of 685 thyroglossal duct remnant cysts.
      ]. They have bimodal incidence peaks in patients between 10 and 19 years of age and those in their 50s [
      • Thompson L.D.
      • Herrera H.B.
      • Lau S.K.
      A clinicopathologic series of 685 thyroglossal duct remnant cysts.
      ]. Thyroglossal duct cysts are often located at or just below the hyoid bone adjacent to the thyrohyoid periosteum [
      • Rosenberg T.L.
      • Brown J.J.
      • Jefferson G.D.
      Evaluating the adult patient with a neck mass.
      ]. They are often first noticed as a mobile mass under the hyoid bone in the midline anterior neck [
      • Thompson L.D.
      • Herrera H.B.
      • Lau S.K.
      A clinicopathologic series of 685 thyroglossal duct remnant cysts.
      ]. They move superiorly on swallowing or protrusion of the tongue [
      • Rosenberg T.L.
      • Brown J.J.
      • Jefferson G.D.
      Evaluating the adult patient with a neck mass.
      ]. Tenderness is absent or mild when present [
      • Thompson L.D.
      • Herrera H.B.
      • Lau S.K.
      A clinicopathologic series of 685 thyroglossal duct remnant cysts.
      ]. The cysts enlarge with upper respiratory infections [
      • Rosenberg T.L.
      • Brown J.J.
      • Jefferson G.D.
      Evaluating the adult patient with a neck mass.
      ]. With infection/abscess (about 20% of cases), the cysts become painful, with erythema and calor, and patients experience neck pain. CT examination reveals a clearly defined uniform cyst surrounded by a thin, contrast-enhanced wall. In patients with repeated infection, the Sistrunk procedure can be used (excision of a part of the hyoid bone and the residual thyroglossal duct along with the cyst) [
      • Thompson L.D.
      • Herrera H.B.
      • Lau S.K.
      A clinicopathologic series of 685 thyroglossal duct remnant cysts.
      ].
      Therefore, it is important to consider a thyroglossal duct cyst in patients presenting with a cystic mass near the hyoid bone in the midline anterior neck caused by an upper respiratory tract infection.

      Funding

      None.

      Declaration of Competing Interest

      None.

      Acknowledgments

      None.

      Appendix. Supplementary materials

      References

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