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HEAD & NECK RADIOLOGY Table of Contents   
Year : 1999  |  Volume : 9  |  Issue : 4  |  Page : 187-189
Cervical thymic cyst


Kasturba Medical College, Light House Hill, Mangalore-575001, India

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Keywords: Thymus, Cyst, Neck, Cervical

How to cite this article:
Ballal H S, Mahale A, Hegde V, Shetty R, Bhavikatti M, Naik S. Cervical thymic cyst. Indian J Radiol Imaging 1999;9:187-9

How to cite this URL:
Ballal H S, Mahale A, Hegde V, Shetty R, Bhavikatti M, Naik S. Cervical thymic cyst. Indian J Radiol Imaging [serial online] 1999 [cited 2020 Jun 2];9:187-9. Available from: http://www.ijri.org/text.asp?1999/9/4/187/28351

   Case Report Top


A thirteen-year old boy presented to us with diffuse swelling and moderate pain in the right side of the neck. The swelling had been noticed two months prior to presentation and gradually increased in size becoming painful a week before the patient presented to us.

An ultrasound of the neck (SSH-140 A, Toshiba, Japan) was performed followed by CT scan (Somatom CR, Siemens, Erlangen). On sonography we noticed a hypoechoic linear area extending from the neck into the superior mediastinum. It was present between the internal jugular vein and the carotid vessels in the neck and was posteromedial to the sternocleidomastoid muscle in the neck, extending inferiorly into the superior mediastinum on the right side. The thyroid gland was medial to the cystic lesion [Figure - 1],[Figure - 2].

Axial CT scans showed a hypodense area with fluid density (5-20 HU) extending from the carotid triangle into the right upper thoracic paratracheal region. It was bounded laterally by the internal Jugular vein, anterolaterally by the sternocleidomastoid muscle, medially by the common carotid artery and right lobe of the thyroid gland and posteriorly by the vertebral artery and the longus colli and scalenus muscles. Inferiorly, in the superior mediastinum it was in the right paratracheal region [Figure - 3],[Figure - 4]. Our provisional diagnosis was a branchial cleft cyst with a differential diagnosis of cervical thymic cyst.

Histopathologically, the diagnosis was a cervical thymic cyst.

[TAG:2]Discussion[/TAG:2]

The usual etiologies of neck masses in children are cystic hygroma, branchial cleft cyst if located laterally and thyroglossal cyst, if in the midline.[1]

The most common midline lesion of the neck in a child is from thyroglossal remnants. These can be found at any level, from the base of the tongue to the thyroid isthmus and can present as thyroglossal cysts or sinuses, the latter confirming the diagnosis if demonstrable [2].

Nests of thymic tissue may be found anywhere along the descent of the thymic primordia from the angle of the mandible to the mediastinum. Mediastinal extension is seen 50% of cervical thymic cysts [4].

Speer originally described five causes of these cysts:

  1. Remnants of embryological thymopharyngeal ducts,
  2. Sequestration products of thymic involution,
  3. Degeneration of Hassal's corpuscles (epithelial cells aggregated into concentric onionskin layers of keratinized cells),
  4. Connective tissue, lymph nodes and blood vessels arrested in various stages of thymic development,
  5. Neoplastic changes in lymphoreticular or connective tissues [5].


Ultrasound and CT scan are both good modalities to assess cervical thymic cysts. They help in surgical planning and assessing the extent of the lesion [5]. On ultrasound, they appear as hypoechoic masses with few septae and internal echoes. CT scan with contrast shows better margination and their relationship to the adjacent vessels. They are hypodense and well defined with minimal enhancement of the margins on contrast scans. MR can also be used for superior soft tissue evaluation. The lesions are hypointense on T1W images and hyperintense on T2W images. These lesions usually lie medial to the sternocleidomastoid muscle, anterior to the carotid sheath and lateral to the thyroid gland.[7]

 
   References Top

1.Reede DL, Whelan AM, Gengeron RT. CT of the soft tissue structures of the neck. Radiologic Clinics of North America 1984; 22-1: 239-250.   Back to cited text no. 1    
2.Solomon JR, Rangecroft L. Thyroglossal duct lesions in childhood. Journal of Paediatric Surgery 1984; 19: 555-561.   Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Kraus R, Han BK, et al . Sonography of neck masses in children. American Journal of Roentgenology 1986; 146: 609-613.   Back to cited text no. 3    
4.Nguen Q, Tar M de, et al . Cervical thymic cyst: case reports and review of literature. Laryngoscope 1996; 106: 247-252.   Back to cited text no. 4    
5.Jones JE, Hession B, Cervical thymic cysts. ENT _ Ear, Nose and Throat Journal 1996; 75-10: 678-680.   Back to cited text no. 5    
6.Tovi F, Mares AJ, The aberrant cervical thymus: embryology, pathology and clinical implications. American Journal of Surgery 1978; 136:631-637.   Back to cited text no. 6    
7.Zarbo RJ, McClatchey KD, et al . thymopharyngeal duct cyst: a form of cervical thymus. Ann Otol Rhinol Laryngol 1983; 92:284-289.   Back to cited text no. 7    

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Correspondence Address:
H S Ballal
15-6-326/4 Rakshan, Bunts Hostel Road, Opp. Hotel Woodlands, Mangalore 575 003
India
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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]

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