Radiological features of the differential diagnosis of cystic lesions in the pediatric head and neck: a case series report

Introduction: Cystic lesions of the pediatric head and neck encompass a broad spectrum of congenital, inflammatory, and neoplastic conditions, with the majority being benign. Accurate diagnosis is essential as clinical presentation often overlaps, while management strategies vary significantly. This paper reviews the embryological background, clinical features, radiological characteristics, and differential diagnosis of common pediatric cystic lesions, including thyroglossal duct cysts, branchial cleft cysts, dermoid and epidermoid cysts, cystic hygromas, plunging ranulas, and cervical thymic cysts. This case series aims to describe the radiological features of pediatric cystic neck lesions and to highlight their differential diagnosis to avoid misdiagnosis. Case description: A case series of five pediatric patients is presented, each illustrating characteristic imaging findings confirmed with computed tomography (CT) and magnetic resonance imaging (MRI). Key diagnostic considerations include patient age, lesion location (midline vs. lateral), history of infection, and radiological features such as cyst wall thickness, septation, and enhancement patterns. Conclusion: Ultrasound serves as the first-line imaging modality to differentiate cystic from solid masses, while CT and MRI provide superior anatomical delineation and staging. Recognition of these imaging features is critical for guiding diagnosis, avoiding misinterpretation as malignancy, and determining appropriate surgical or conservative management.