Sonographic Characteristics of Brachial Cleft Cysts and Brachial Cleft Fistulas

  Objective  To investigate the value of gray-scale and color Doppler ultrasound in the diagnosis of brachial cleft cysts and brachial cleft fistulas.

  Methods  The sonographic and clinical records of 19 patients with pathologically proven brachial cleft cysts and brachial cleft fistulas between January 2010 and January 2014 were retrospectively reviewed and the sonographic characteristics of the brachial cleft abnormalities were analyzed.

  Results  Fourteen cases were diagnosed as brachial cleft cysts (5 were First, 9 were Second), 5 cases were diagnosed as brachial cleft fistulas (1 was First, 2 were Second, 1 was Third, 1 was Fourth). On the ultrasound, the brachial cleft cysts manifested as round or oval in 92.8% (13/14), and 85.7%(12/14) had a sharp border; 50.0%(7/14) were echo-free, and floating echo points could be found in 2 of them. Also, 14.3%(2/14) had solid cysts with small cystic structure, and 28.6% (4/14) had purely heterogeneous solid cysts. Color Doppler flow imaging(CDFI) showed 28.6%(4/14) were peripherally vascularized and 71.4%(10/14) were not vascularized. In the 5 patients with brachial cleft fistulas, 4(80%) had hypo-echoic strips or irregular shape, 2(40%) showed the fistula, 3(60%) were solid, and 2(40%) were mixed solid and cyst. CDFI showed 2(40%) were inner-part vascularized, 1(20%) was peripherally vascularized, and 2(40%) were not vascularized.

  Conclusion  Brachial cleft cysts and brachial cleft fistulas have typical ultasound manifestations, which can guide the preoperative diagnosis of these diseases.