Infected Branchial Cleft Cyst Presenting as a Recurrent Peritonsillar Abscess

Abstract

Objective: Peritonsillar abscess (PTA) is the most common deep infection of the head and neck in young adults. The incidence of recurrent unilateral PTA is extremely low, and a patient with recurrent unilateral PTA development deserves a more vigorous workup for other pathologic entities, including branchial cleft cysts (BCC).

Method: We describe a unique clinical case illustrating the workup and diagnosis of a patient presenting with “recurrent unilateral PTA” that actually turned out to be a second BCC. We discuss the necessity to keep a broad differential when evaluating patients presenting with “classic” symptomatology.

Results: A 40-year-old male presented to the emergency department with a history of 5 previous right-sided PTAs. The patient was again treated for “recurrent PTA” due to computed tomography (CT) scan and physical examination findings. An outpatient CT scan later showed a residual fluid collection in the peritonsillar and parapharyngeal space. The patient was subsequently taken to the operating room for a definitive exploration where a second BCC was discovered and removed.

Conclusion: BCCs may be asymptomatic but commonly present as recurrent infected neck abscesses. In any patient who presents with recurrent unilateral PTAs, a broader differential diagnosis should be formulated (including BCC), and necessary imaging studies should be ordered to properly classify and treat these individuals.