Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology
The patient was a 3 year old male with a large midline neck mass that caused discomfort.
Clinical Physical Exam:
Large midline mass in the neck.
Images 1 and 2
Clinical Differential Diagnosis:
Thyroglossal duct cyst
An I-123 thyroid scan showed tracer uptake solely in the midline neck mass.
Imaging Differential Diagnosis:
Circular midline thyroid within a thyroglossal duct cyst.
Two and one-half years later, the child was taken to the operating room for elective removal of this mass due to the discomfort it caused, even though this meant removing the child's only functioning thyroid tissue. A transverse incision was made to expose the mass which was seen to be intimately adherent to the hyoid bone at its mid-point. A central tract extending up to the foramen cecum was identified and ligated. Then, the entire mass with its tract up to the foramen cecum was excised along with the central portion of the hyoid bone. After removal the mass was incised and seen to have a jelly-like cyst fluid.
Images 4 and 5
Examination of the surgical specimen revealed findings classic for a thyroglossal duct cyst containing thyroid gland tissue.
Thyroglossal Duct Cyst containing Thyroid Gland Tissue
Follow-up and Prognosis:
The patient did well post operatively but must remain on thyroid hormone replacement for the remainder of his life due to the removal of all of his functioning thyroid tissue.
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