Congenital anomalies of the branchial apparatus: embryology and pathologic anatomy

Various congenital anomalies of branchial origin are found in the neck region. Understanding the varied radiologic appearances of these anomalies is greatly aided by familiarity with their embryologic origins. By considering the anatomic location and radiologic appearance, the precise embryologic origin can be accurately predicted. Defects of the branchial apparatus include branchial, thymic, and parathyroid anomalies, which may manifest as cysts, sinuses, fistulas, and ectopic glands. The embryologic model is used to explain the origins of all branchial apparatus anomalies. The most accepted theory proposes that vestigial remnants result from incomplete obliteration of the branchial apparatus or buried cell rests, and, thus, if cells are trapped in the branchial apparatus during the embryologic stage, they can form branchial cysts later in life. By understanding the embryologic basis for these defects, the radiologist is better able to interpret the findings encountered with the various imaging modalities used in the evaluation of these anomalies.