Identification of a branchial cleft anomaly via handheld point-of-care ultrasound.

Aim of the study: Branchial anomalies result from incomplete obliteration of the branchial arch structures during embryogenesis. Second branchial arch anomalies are commonly found on the lower third of the neck, with an opening at the anterior border of the sternocleidomastoid muscle, and may drain secretions or purulent material. This case demonstrates the use of handheld point-of-care ultrasound to aid in the diagnosis of a branchial anomaly. Case description: The patient presented with a "hole" in the neck with intermittent drainage from the site. A 2 mm defect in the skin was noted anterior to the sternocleidomastoid muscle. A handheld ultrasound system was used to identify a well-defined, hypoechoic, cyst-like structure. Given the history, physical findings, and point-of-care ultrasound imaging, the diagnosis of a second branchial cleft sinus was made. Conclusions: The use of point-of-care ultrasound and knowledge of the sonographic characteristics of these lesions can assist the physician in the diagnosis of branchial arch anomalies.

An ominous cause of back pain: Vertebral Osteomyelitis.

The authors present the case of a patient seen for back pain in the emergency department, initially discharged home with a diagnosis of musculoskeletal pain. He returned a week later and was found to have vertebral osteomyelitis based on a thorough neurologic exam. A review of ominous causes of back pain, including the elusive nature of vertebral osteomyelitis/diskitis is discussed.