Branchial cleft remnants are seen clinically as cysts, sinus tracts, skin tags, or various combinations of these lesions. The case of a 26year-old girl of Mexican heritage was presented in which cervical epidermal cysts were noted in such number and location to suggest they represented remnants of the first branchial cleft.
Because she reported frequent upper respiratory infections, cervical lymphadenopathy, and prior treatment of what was thought to be scrofuloderma, it was necessary to exclude the diagnosis of tuberculosis of the cervical lymph nodes.
A friable syringocystadenoma papilliferum of the scalp further complicated the clinical evaluation in her case because the most common cause of masses in the neck, with the exception of benign thyroid enlargement, is metastatic cancer in the lymph nodes.
Foote JE, Anderson PC. Branchial Cleft Remnants Suggesting Tuberculous Lymphadenitis. Arch Dermatol. 1968;97(5):536-539. doi:10.1001/archderm.1968.01610110044007