Emergency Management of Infected Branchial Cysts: Differentiation from Metastatic Disease

Overview

A practical emergency ENT approach to a lateral cystic or infected neck mass: when is it truly an infected branchial cleft cyst, when has it become a deep neck abscess requiring drainage, and when is the “cyst” actually a cystic metastatic node from an occult malignancy? The rule on call is clear: secure the airway first, treat sepsis and abscess when present, and never open a cold cystic neck mass in an adult as a presumed branchial cyst before malignancy has been excluded.