Unusual presentations of branchial cysts: a trap for the unwary.

Twenty-three cases of branchial cysts seen over 4 years are described. Only 11 patients presented with simple non-tender fluid swellings of the neck. Five patients presented with tender masses during infections and were diagnosed as acute abscesses. Seven patients presented with hard fixed masses mimicking lymphadenopathy. None of these were diagnosed correctly before surgery. Misdiagnosis led to significant morbidity from persistent cervical discharges. One patient had a partial nerve palsy. Infection of branchial cysts was common in this series and caused difficulties in diagnosis due to thickening of cysts walls following chronic inflammation in lymphoid tissue.