A Rare Case of Communicating Neck Cyst in a 28-Day-Old Neonate.

Congenital neck anomalies in neonates often present diagnostic dilemmas, particularly when they communicate with the aerodigestive tract. This report describes a rare case of a large, compressive neck cyst in a 28-day-old neonate. Initially presenting as a progressively enlarging cervical mass, the lesion's potential for airway communication was identified by the presence of intralesional air-fluid levels on computed tomography and magnetic resonance imaging. Advanced diagnostic techniques, including virtual bronchoscopy and intraoperative laryngoscopy, were utilized to successfully localize a direct communication between the cyst and the left false vocal cord. This finding confirmed the diagnosis of a rare branchial apparatus anomaly rather than a simple cervical abscess or cystic hygroma. The patient underwent definitive management through complete surgical excision and ligation of the communicating tract, resulting in a full recovery without recurrence. This case highlights the importance of recognizing specific radiological markers, such as air-fluid levels, as indicators of airway communication. It further emphasizes that while these lesions may mimic infectious processes, successful outcomes rely on a high index of clinical suspicion, precise anatomical localization through multimodal imaging, and definitive surgical intervention over simple drainage procedures.