Evaluating the role of ultrasound in diagnosing and managing congenital branchial cleft anomalies in children.

PURPOSE: This study aimed to examine the ultrasound imaging characteristics of congenital branchial cleft anomalies (BCAs) in children and their clinical applications, providing a minimally invasive method for preoperative evaluation and treatment.

METHODS

This single-centre retrospective study (July 2021-April 2024) analysed 308 paediatric BCA cases. Clinical, intraoperative, and ultrasound data were compared to establish imaging criteria and inform management.

RESULTS

Among the 308 patients (mean age 6.45 ± 5.24 years), 8 were neonates. Unilateral anomalies were observed in 282 patients (right: 68, left: 214), whereas bilateral anomalies were observed in 26 patients. The male-to-female ratio was 1:1.3. First branchial cleft anomalies (FBCAs) developed in 84 patients (27.2%), second branchial cleft anomalies (SBCAs) in 160 (51.9%), congenital pyriform sinus fistulas (CPSF) in 42 (13.6%), and sinus sternoclavicularis (SSC) in 22 (7.3%). Preoperative ultrasound-guided aspiration was performed in 14 patients (8 neonates with CPSFs and 6 with SBCAs) to reduce lesion size. FBCAs presented as hypoechoic masses around the inferior cartilage of the external auditory canal, extending to the parotid gland. SBCAs appeared as hypoechoic or irregular mixed echoes around the sternocleidomastoid muscle. CPSFs showed uneven echogenicity at the upper pole of the ipsilateral thyroid. Ultrasound revealed an enlarged pyriform sinus opening and gas echoes within the thyroid. Neonatal CPSFs appeared as well-defined, oval, gas-containing, hypoechoic masses. SSCs presented as subcutaneous hypoechoic or irregular mixed-echoic tubular structures near the sternoclavicular joint.

CONCLUSION

Ultrasound effectively demonstrates the imaging characteristics and course of BCAs in children, providing valuable guidance for treatment. As a noninvasive and radiation-free modality, it often serves as a primary diagnostic tool, providing a safe and highly effective approach for the initial evaluation and management of BCAs.