Branchial cyst: an often forgotten diagnosis.

To study the clinical presentations, diagnosis and management of patients with the pathological diagnosis of branchial cysts. This was a retrospective analysis of the records of 33 patients with the diagnosis of branchial cyst, seen between 1987 and 2003 at the General Surgical Unit of Jordan University Hospital. Thirty-four cases of branchial cysts were seen in 33 patients: 22 females and 11 males. There was a wide range in age (1-57 years), but the majority (25 patients) were in their second or third decades of life. Thirty-one cysts occurred in the classical site. The same number of branchial cysts occurred on the right and left sides of the neck (17 on the right and 17 on the left). Correct clinical diagnosis was made in only 14 cases (41.2%). Branchial cysts are frequently incorrectly diagnosed and forgotten in the differential diagnosis. Thus, the diagnosis is often delayed, resulting in the mismanagement of these patients. Branchial cyst should be suspected in any patient with a swelling in the lateral aspect of the neck, regardless of whether the swelling is solid or cystic, painful or painless. Fine needle aspiration cytology will accurately demonstrate the cystic nature. The presence of cholesterol crystals and/or epithelial cells in the aspirate will suggest the diagnosis of branchial cyst.