This is the most common congenital midline neck mass. It accounts for 90% of congenital neck lesions. The foramen caecum (at the tongue base) connects to the thyrohyoid membrane, ending at the thyroidal isthmus. If this does not involute during development, it forms a tract/sinus along which thyroid tissue can arrest. Commonly infrahyoid (65%) and 15% are suprahyoid. There is rarely malignant transformation to SCC.

•  Best on sagittal imaging.
•  Homogeneous high signal on T2, low on T1.
•  Wall may enhance if the cyst is infected.

 Calcification or nodular tissue suggest malignancy.


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