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Upper lateral neck swelling: rare but important differential diagnosis.

A 20-year-old Malay female with no medical illness presented with a painless right upper neck swelling of few weeks duration. It was slowly increasing in size. The mass was located at the upper one-third of right sternocleidomastoid muscle which was fi rm in consistency. It measured 4 cm x 6 cm. She was treated for cervical lymphadenitis with a few courses of antibiotics. As the mass did not subside, and other ear, nose, throat (ENT) examinations showed normal fi ndings, she was sent for ultrasonography of the neck and fi ne needle aspiration (FNA) of the mass. A well-defi ned heterogenous hyperechoic mass splaying carotid arteries was demonstrated. As the lesion was located at the carotid artery bifurcation, a computed tomography (CT) angiography was obtained (Fig. 1).