Endocrine Abstracts

Introduction: Fourth branchial cleft cyst are commonly reported as recurrent low-neck abscesses, acute suppurative thyroiditis, and neck masses. We report an accidental finding of a fourth branchial cleft as a suspected thyroid nodule.

Case presentation: We present a case of a 47-year-old woman who consulted the Ear, Nose, and Throat department of our hospital with a 4-year history of thyroid nodule. The thyroid nodule was discovered incidentally on ultrasonography. She reported no cervical swelling, pain, dysphagia, dysphonia or dyspnea. She did not report any recent infections, neck trauma, or surgery. The patient had no palpable neck mass or fistulous orifices, with a strictly normal ENT examination. Several ultrasonographic examinations revealed the thyroid nodule. Its size was a 14*8*7 mm tissular nodule classified EU-Tirads 5 but didn’t show a cyst, without significant modification compared to the previous ultrasonographic examinations. The patient underwent lobo-isthmectomy. The patient’s postoperative course was satisfactory. Meanwhile, the pathologist confirmed the presence of a 1 cm lateral neck cyst within this thyroid lobe with no other thyroid nodules. After a mean follow-up of 5 years, no superinfection episodes or recurrence were reported.

Conclusion: Fourth branchial anomalies are very rare and can remain asymptomatic for a long time. Its localization and mode of discovery may be unusual. Clinical presentation and imagery can’t always help to diagnosis. In our case, it was considered as a suspicious thyroid nodule, but the anatomopathological examination rectified the diagnosis.