Bilateral Branchial Fistulae and Cervical Rib

Abstract

An 18-year-old female presented with bilateral openings on each side of midline at lower 1/3rd of neck since birth and a swelling in left anterior triangle of neck for last seven years. There is history of clear discharge from both the openings. Never had any purulent discharge or signs of inflammation around them. Seven years back patient noted a hard swelling on the left side of neck associated with pain in left arm on heavy manual work relieved by taking rest. On examination there was 3x4-cm swelling, hard in consistency, overlying skin was normal and showed pulsations on its lateral margin. Her left radial pulse used to diminish when hand was lifted above the head. Her X-ray chest revealed cervical rib on left side. Her Doppler study revealed normal veins in left upper limb. Left subclavian artery was bit ectetic while passing anterior to left cervical rib with post curve minimal dilatation (5.5mm pre-curve diameter and 9 mm post-curve diameter) with again normal diameter later on. Left Axillary, brachial, radial and ulnar arteries were normal. After making diagnosis, operative treatment (excision of B/L branchial fistulae and Left cervical rib) was offered to the patient Continued.