Case 2. Diagnosis: Anterior Neck Dermoid. They are usually located midline or off midline (suprasternal, tongue, nasal, anterior fontanelle, occipital). Contain epithelial and mesodermal elements (fat, cartilage, bone). Unilocular cystic mass, which may have negative HU on CT. MRI has variable signal intensity on T1 and T2 depending on content. T1 signal may suppress using fat suppression techniques. The classic sac-of marbles appearance as demonstrated in this case is due to coalescence of fat into small globules. Enhancement is typically absent. Differential diagnosis in this case would be an off midline thyroglossal duct cyst. A more encompassing differential (cystic pediatric neck masses) would also include…

  1. Branchial cleft cyst (has to be in the correct location)
  2. Lymphatic malformation (typically multilocular)
  3. Thymic cyst (newborn presentation)
  4. Ranula (floor of mouth)
  5. Cystic metastasis (uncommon in children) and necrotic tumors or lymph nodes


Case 1. Diagnosis: Bilateral Choanal Atresia. Present in neonatal period with respiratory distress due to being obligate nasal breathers. Most commonly a combination of membranous and osseous components. This case shows membranous osseous atresia with widened posterior vomer and hypertrophic posterior lateral nasal walls. Always look at orbits (coloboma) and temporal bones (absent semicircular canals) for possible CHARGE diagnosis. Differential diagnosis fro nasal obstruction in the newborn includes piriform aperture stenosis, mass lesions, mid nasal stenosis, and encephalocele. Posted August 1, 2018

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