DrVirgo
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34. A full-term male neonate is born with a 4x4-cm mass posterior to the right sternocleidomastoid muscle. Delivery was uncomplicated and Apgar scores were 9 and 9 at 1 and 5 minutes, respectively. The mass is unilocular and filled with watery fluid; no other abnormalities are present. The most likely diagnosis is
A) branchial cyst
B) cystic hygroma
C) preauricular sinus
D) thyroglossal duct cyst
E) Zenker's diverticulum
I think A...or B.... Anyone know for sure? and why? Thanks. 
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| yasmeen
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ITS A USUAL LOCATION OF BRACHIAL CYST IS MENTIONED
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| robin082006
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| DrVirgo
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I agree with A as well... But why can't it be D?
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| DrVirgo
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Someone told me it can't be A because Branchial cysts are always ANT. to SCM muscle, and furthermore, branchial cysts are not present at birth, so answer is B.
Can anyone confirm this???
I still think its A.
But now i'm confused. 
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| r_albayunen
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my opinion.. thyroglossal cysts will be never be lateral nor posterior to sternocleidomastoid muscle .. they will be medial and will go up and as u swallow ..they are medially loc ... branchial cysts are lateral
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| DrVirgo
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I agree r_al, (thyroglossas cysts are always medially located)
but what about branchial versus cystic hygroma?
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| girl^interrupted
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Cystic hygroma are irregular and multiloculated(Qs stem says unlilocular). Lateral side of neck is a specific location for the branchial cyst which seems to be the most likely answer. though anterior border of sternocleidomastoid is more likely BUT can occur anywhere in the lateral neck and is unilocular.
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| DrVirgo
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Thanks girl.... that cleared up a lot of my doubts. 
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| krsna
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hought branchial fistulas present at hte ant border of scm...and branchial cysts at the angle of mandible, behind the scmuscle...
pls clarify
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| waqastariq
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its A .. cystic hygroma is all over the neck usually by the time of birth
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| Cedrick
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Cystic hygroma
Choice B
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| docarchana
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ITS b..
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| hope99
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i believe it's B too
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| suv
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i too think its B
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| oldkidontheblock
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http://www.birthmarks.us/LM.htm
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| new_n_lost
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Cystic Hygromas (Lymphangiomas). A cystic hygroma is a lymphangioma that arises from vestigial lymph channels in the neck. Almost always, this condition is first noted by the second year of life; on rare occasions, it is first diagnosed in adulthood. A cystic hygroma may present as a relatively simple thin-walled cyst in the floor of the mouth or may involve all the tissues from the floor of the mouth to the mediastinum. About 80% of the time, there is only a painless cyst in the posterior cervical triangle or in the supraclavicular area. A cystic hygroma can also occur, however, at the root of the neck, in the angle of the jaw (where it may involve the parotid gland), and in the midline (where it may involve the tongue, the floor of the mouth, or the larynx).
The typical clinical picture is of a diffuse, soft, doughy, irregular mass that is readily transilluminated. Cystic hygromas look and feel somewhat like lipomas but have less well defined margins. Aspiration of cystic hygromas yields straw-colored fluid. They may be confused with angiomas (which are compressible), pneumatoceles from the apex of the lung, or aneurysms. They can be distinguished from vascular lesions by means of arteriography. On occasion, a cystic hygroma grows suddenly as a result of an upper respiratory tract infection, infection of the hygroma itself, or hemorrhage into the tissues. If the mass becomes large enough, it can compress the trachea or hinder swallowing.
In the absence of pressure symptoms (i.e., obstruction of the airway or interference with swallowing) or gross deformity, cystic hygromas may be treated expectantly. They tend to regress spontaneously; if they do not, complete surgical excision is indicated. Excision can be difficult because of the numerous satellite extensions that often surround the main mass and because of the association of the tumor with vital structures such as the cranial nerves. Recurrences are common; staged resections for complete excision are often necessary.
here is the link for further reference http://www.medscape.com/viewarticle/535614
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| mediocre
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yep,Cystic Hygroma!
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| klimt
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I think it's a branchial cyst
doesn't cystic hygroma reffer to lymphedema=webbed neck in Turner Sd?
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| ManuNastai
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 isn't it obvious that is A?
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| drfax
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A
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| proctalgia
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A agreed
A cystic hygroma is unlikely in a neonate.
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| vallia
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I think it's cystic hygroma
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| smal
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cystic hygroma will be multiloculated,may have other lymphodema features and cholestrol and viscid material on aspitation
ya branchial cysts are FOUND MOST COMMONLY ON ANTEROMEDIAL LOWER THIRD OF sm MUSCLE,yet they describe in qt a unilocular and watery fluid containinf cyst,which very much goes with branchial cyst
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| Diego Casali
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I think A is the correct answer.
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