Imaging features and therapeutic approaches for congenital branchial anomalies in 1668 pediatric cases.

PURPOSE: To summarize the imaging features of congenital branchial anomalies (CBA) in children based on a large single‑center cohort, propose cohort-based stratified diagnostic criteria and individualized surgical strategies, and provide a reference for the precise clinical management of pediatric CBA.

METHODS

A retrospective study analyzed 1,668 pediatric CBA at the Children's Hospital of Zhejiang University between January 2017 and December 2024. Data regarding gender, age, lesion laterality, infection history, lesion type, imaging features, and treatment regimens were summarized and evaluated.

RESULTS

The cohort included 936 males (56.1%) and 732 females (43.9%), with a median age of 3.02 years. Lesions were left-sided in 83.2% of cases, and 83.6% had infection histories. The diagnostic protocol proposed ultrasound as the preferred modality for pyriform sinus fistulas and sternoclavicular sinuses; ultrasound with magnetic resonance imaging for first branchial anomalies; and multislice computed tomography fistulography (MSCTF) for second branchial cleft fistulas. Post-surgical recurrence occurred in 57 cases (3.4%), The complication rate was 2.3%.

CONCLUSION

Optimized imaging protocols can improve the diagnostic accuracy of pediatric CBA, guide surgical planning and enhance clinical outcomes.