A fatal case of severe neck abscess due to a third branchial cleft fistula: morphologic and immunohistochemical analyses
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CASE REPORT
Open Access
A fatal case of severe neck abscess due to a third branchial cleft fistula: morphologic and immunohistochemical analyses Fang Tong1, Yue Liang1, Muhammad Fasahat Khan2, Lin Zhang1, Wenhe Li1, Mohammed Mahmoodurrahman2 and Yiwu Zhou1*
Abstract Background: Branchial cleft anomalies constitute a frequently encountered and commonly non-lethal disease in otolaryngology, and result from aberrant embryonic development. The third branchial cleft fistula is one of the four known specific types of branchial cleft anomalies, and always presents as recurrent neck abscess and suppurative thyroiditis. Here, we report an unexpected death due to severe neck infection following a third branchial cleft fistula. Case presentation: A 19-year-old man was sent to the hospital with a 1-week history of recurrent left-sided neck abscess, and was scheduled for incision and drainage of the abscess. However, before the surgery was performed, the man’s condition deteriorated and he died. A review of his medical history showed that he had undergone a previous incision and drainage for a neck abscess 2 years ago. Postmortem examination revealed that the fatal neck abscess was induced by a third branchial cleft fistula. Conclusions: We conclude that a histopathological examination of neck tissue combined with a detailed review of medical history and examination of ultrasonographic and CT images can provide a rapid and accurate diagnosis of third branchial cleft fistula. This common, non-lethal disease can potentially lead to death if the neck infection is not properly diagnosed and treated. In medico-legal practice, medical examiners should be aware of this condition, as this knowledge would be important in the diagnosis of the cause of death. Keywords: Third branchial cleft fistula, Branchial cleft anomaly, Neck abscess, Immunohistochemistry
Background Branchial cleft anomalies are frequently encountered by otolaryngologists and constitute one of the uncommon anomalies of embryonic development [1]. They arise from malformations occurring during development of the fetal branchial apparatus and formation of the epithelized tract, and these, in turn, may give rise to some congenital anomalies of the head and neck region [2]. Approximately 17 % of all pediatric neck masses are related to branchial cleft anomalies [1].
* Correspondence: [email protected] 1 Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong RoadHankou, Wuhan 430030, People’s Republic of China Full list of author information is available at the end of the article
The third branchial cleft fistula is a rare type of branchial cleft anomaly that only accounts for 2–8 % of all the anomalies [3, 4], with approximately 94 % of these anomalies found on the left side [5]. Anatomical findings show that the third branchial cleft fistula passes along the carotid sheath and then travels between the glossopharyngeal and hypoglossal nerves. It pierces the thyrohyoid membrane and tracks above the sup
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