Large Cervical Branchial Cleft Cyst in Adulthood Revealed by Airway Symptoms.

Fourth branchial cleft anomalies are exceedingly rare, especially in adult patients. Their presentation can mimic other cervical masses, posing a diagnostic challenge. This case underscores the importance of considering branchial cleft cysts in the differential diagnosis of anterior neck swellings in adults. We report a case of a 33-year-old patient who presented with a progressively enlarging anterior cervical mass associated with airway symptoms. Clinical examination revealed a soft, non-tender mass displacing the trachea. Cervical computed tomography (CT) demonstrated a well-defined cystic lesion consistent with a branchial cleft cyst. The patient underwent complete surgical excision of the mass. Fourth branchial cleft anomalies are exceptionally rare, particularly in adults, and often present with non-specific symptoms such as dysphonia, dysphagia, or dyspnoea due to their complex anatomical course. These cysts may mimic other cervical pathologies, making their diagnosis challenging. Imaging, especially CT, plays a crucial role in identifying the lesion and its relationship to surrounding structures. Surgical excision remains the definitive treatment, with careful dissection required to preserve adjacent neurovascular and endocrine structures. Our case emphasizes the importance of including fourth branchial cleft cysts in the differential diagnosis of anterior neck masses and illustrates successful management through complete surgical excision. Fourth branchial cleft cysts, although rare in adults, should be included in the differential diagnosis of anterior neck masses with airway symptoms. Prompt diagnosis and surgical excision offer excellent outcomes and prevent complications.