CLINICAL AND ULTRASONOGRAPHIC FINDINGS OF AN INFECTED THYROGLOSSAL DUCT CYST IN A 10-YEAR-OLD BOY: A CASE REPORT

Formerly Published in Vol. 12 No. 3 Jan. - Jun., 2025

Abstract

Background: Thyroglossal duct cysts (TGDCs) represent the most common congenital midline neck masses in children, resulting from persistent remnants of the embryologic thyroglossal duct. While typically benign, TGDCs may become secondarily infected or ulcerated, complicating clinical diagnosis and management. This case underscores the diagnostic utility of clinical and ultrasonographic findings when microbiological confirmation is unavailable.

Case Presentation: A 10-year-old boy presented with a two-year history of a recurrent anterior neck swelling associated with purulent discharge and overlying ulceration. Physical examination revealed a 2*4 cm midline cystic mass that elevated with tongue protrusion and deglutition. Neck ultrasonography demonstrated a well-defined cystic lesion without ectopic thyroid tissue or lymphadenopathy. Fine-needle aspiration cytology revealed pseudostratified ciliated columnar epithelium and with a proteinaceous fluid, confirming TGDC. Empirical antibiotics were initiated, and the patient was scheduled for elective Sistrunk procedure following infection resolution.

Discussion: This case illustrates three key clinical lessons:

Diagnostic Approach: In resource-limited settings, TGDC diagnosis can be reliably made using clinical features (mobile midline mass) and ultrasonography, even without microbiological confirmation.
Imaging Value: Ultrasonography serves as a first-line tool for evaluating pediatric neck masses, though it has limitations in assessing suprahyoid tracts.

Surgical Timing: The Sistrunk procedure remains the gold standard for definitive treatment but should be deferred until active infection resolves to minimize complications.

Conclusion: Clinical and ultrasonographic findings are sufficient for diagnosing complicated TGDCs when cultures cannot be obtained. Timely surgical referral after infection control is critical to prevent recurrence. This case highlights adaptable diagnostic strategies for low-resource environments while reinforcing standard surgical principles.