Thyroglossal duct cyst (TDC) is the most common midline congenital neck mass accounting for 70% of the congenital neck anomalies. For convenience, these have been classified into cystic masses, which are commonly congenital and cyst-like masses. This pictorial review presents the clinical and radiologic features of the cystic and cyst-like masses of the neck. Fine-needle aspiration cytology (FNAC) may be required for confirmation of diagnosis in some cases. T2-weighted MRI particularly helps to distinguish cystic from solid components. Its multi-planar capability and superior contrast resolution allow precise preoperative anatomical localization, particularly for more deep-seated and locally extensive lesions.
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Magnetic resonance imaging (MRI) has a supplementary role in work-up of cystic neck masses. Computed tomography (CT) is superior as it confirms the findings of US, determines the extent of lesion, and is especially useful in demonstration of calcification or fat within the lesion. Development of three-dimensional technology, color, and power Doppler applications has led to great improvement in its diagnostic utility.
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High-resolution ultrasound (US) is an ideal initial imaging investigation for neck masses as it reveals the cystic nature in most cases and localizes the mass in relationship to the surrounding structures. The latter include various inflammatory and neoplastic diseases. Cystic masses of neck include a wide range of congenital and acquired lesions.
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Although clinical history and examination may suggest the diagnosis, imaging is required to confirm the clinical diagnosis and assess the anatomical extent of the lesion before treatment. Cystic masses of neck are frequently encountered on imaging.