Learning Radiology xray montage

Thyroglossal Duct Cyst

  • Most common congenital anomaly of the neck
    • 2-4% of all neck masses
  • Over half present in the first decade of life but may also be seen in adults
  • Pyramidal lobe of the thyroid is the most common remnant of the thyroglossal tract (50% of population)

  • Etiology
    • Represents a persistent epithelial tract during the descent of the thyroid from the foramen cecum to its final position in the anterior neck
    • Normally this duct obliterates early in fetal life
  • Histologically
    • Well-defined cyst with an epithelial lining composed of either squamous or respiratory epithelium
    • There can sometimes be islands of thyroid tissue lying in the walls of the cysts
    • Cysts are filled with mucoid or mucopurulent material, depending on whether the cyst has been infected
  • Types of thyroglossal duct cysts
    • Infrahyoid type
      • 65% and is mostly found in the paramedian position
    • Suprahyoid type
      • Nearly 20% and is positioned in the midline
    • Juxtahyoid cysts
      • 15%
    • Intralingual location
      • 2%
    • Suprasternal variety
      • 10% of cases
    • Intralaryngeal
      • Very rare
  • Clinical
    • Nontender and mobile masses
    • Infected cysts may manifest as tender masses with
      • Dysphagia
      • Dysphonia
      • Draining sinus
      • Fever
      • Enlarging neck mass
    • Often appear after an upper respiratory tract infection
    • Airway obstruction possible, especially with intralingual cysts
    • The pathognomonic sign is that the cyst moves with tongue protrusion
  • Imaging
    • Ultrasound and CT scanning are the radiologic tools of choice
    • Ultrasound is the gold standard
    • Ultrasound can distinguish between solid and cystic components
    • CT scanning may reveal a well-circumscribed cystic lesion, 2-4 cm in diameter with capsular enhancement
    • Thyroid scanning may be done to rule out the cyst containing the only functioning thyroid tissue
  • Differential diagnosis
    • Dermoid cyst
    • Lymphadenopathy
    • Sebaceous cysts
    • Schwannomas
    • Lymphatic malformations
  • Complications
    • Infection is probably the most common complication
    • Local growth and invasion is extremely uncommon
    • Carcinoma is extremely rare
      • Occurs in about 1% to 2% of patients
    • Thyroid ectopia
      • Fewer than 5% of these cysts actually have ectopic thyroid tissue
  • Treatment
    • Surgical treatment of choice for thyroglossal cysts is the Sistrunk operation
      • Includes dissection of the hyoid bone and the base of the tongue
    • Recurrence is approximately 3-5% and is increased by incomplete excision and a history of recurrent infections
    • Thyroid suppression therapy is done by many practitioners
    • Recurrence is the most common complication and is managed with a central neck dissection


Thyroglossal duct cyst.
Reconstructed CT scan of the neck demonstrates a midline cystic lesion (red arrow) with a slightly enhancing wall. The contents measured fluid density.
For the same photo without the arrows, click here

EMedicine - Congenital Malformations of the NeckTed L Tewfik, MD, FRCSC and Adi Yoskovitch, MD, MSc
Thyroglossal Duct Cyst
- Lawrence M. Simon, M.D. Dept. of Otolaryngology-Head and Neck Surgery-Baylor