Pediatric Neck Swelling: A Case Report of Fourth Branchial Cleft Cyst.

Pediatric neck masses present a diagnostic challenge, encompassing various etiologies, including rare entities like branchial cleft anomalies. Branchial cleft cysts, resulting from incomplete embryonic cleft obliteration, may become symptomatic. This case report describes a seven-year-old boy who presented with a week-long history of fever and progressively enlarging left anterior cervical swelling. Physical examination revealed a fluctuant, non-tender mass, prompting diagnostic investigations. Laboratory results indicated an elevated white blood cell count and inflammatory markers. Computed tomography identified a hypodense, rim-enhancing mass consistent with an abscess secondary to a fourth branchial cleft cyst. Ultrasound-guided aspiration yielded purulent material, confirming Staphylococcus aureus infection. This case highlights the clinical significance of fourth branchial cleft cysts as rare inflammatory neck masses in pediatric patients. The embryological context informs their diverse anatomical manifestations. Surgical excision remains the primary treatment, demanding consideration of anatomical complexities.

Delayed Recognition, Surgical Dilemmas, and Complications: A Case Report of Acute-on-Chronic Subdural Hematoma With Ischemic Stroke.

Acute-on-chronic subdural hematoma (SDH) is a new hemorrhage on a preexisting hematoma in the space between the dura mater and the arachnoid layer. Although chronic SDH is common, acute-on-chronic SDH is not. Herein, we present a case of a 70-year-old male with ischemic heart disease, diabetes mellitus, and hypertension who presented with worsening headaches for the past three days, associated with gait imbalance and dizziness. The patient was vitally stable on examination with a Glasgow Coma Scale/Score (GCS) of 15/15; his pupils were reactive bilaterally; and his neurological examination was unremarkable. Non-contrast computed tomography (CT) of the head yielded acute and chronic SDH. The patient was initially managed by embolization of the middle meningeal artery (EMMA), but one day later he developed a stroke. Hence, thrombectomy and burr hole craniotomy were performed to manage the stroke and evacuate the chronic subdural hematoma (CSDH). This paper presents this case as uncommon acute on chronic SDH presented with headache and vertigo, treated with embolization and with complications of stroke and pulmonary embolism.