title: A fatal case of severe neck abscess due to a third branchial cleft fistula: morphologic and immunohistochemical analyses.
abstract: BACKGROUND
  Branchial cleft anomalies constitute a frequently encountered and commonly non-lethal disease in otolaryngology, and result from aberrant embryonic development. The third branchial cleft fistula is one of the four known specific types of branchial cleft anomalies, and always presents as recurrent neck abscess and suppurative thyroiditis. Here, we report an unexpected death due to severe neck infection following a third branchial cleft fistula.
  
  
  METHODS
  A 19-year-old man was sent to the hospital with a 1-week history of recurrent left-sided neck abscess, and was scheduled for incision and drainage of the abscess. However, before the surgery was performed, the man's condition deteriorated and he died. A review of his medical history showed that he had undergone a previous incision and drainage for a neck abscess 2 years ago. Postmortem examination revealed that the fatal neck abscess was induced by a third branchial cleft fistula.
  
  
  CONCLUSIONS
  We conclude that a histopathological examination of neck tissue combined with a detailed review of medical history and examination of ultrasonographic and CT images can provide a rapid and accurate diagnosis of third branchial cleft fistula. This common, non-lethal disease can potentially lead to death if the neck infection is not properly diagnosed and treated. In medico-legal practice, medical examiners should be aware of this condition, as this knowledge would be important in the diagnosis of the cause of death.
authors.affiliation: Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan, 430030, People's Republic of China.
authors.forename: Fang
authors.initials: F
authors.lastname: Tong
authors.affiliation: Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan, 430030, People's Republic of China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Liang
authors.affiliation: College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
authors.forename: Muhammad Fasahat
authors.initials: MF
authors.lastname: Khan
authors.affiliation: Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan, 430030, People's Republic of China.
authors.forename: Lin
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan, 430030, People's Republic of China.
authors.forename: Wenhe
authors.initials: W
authors.lastname: Li
authors.affiliation: College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Mahmoodurrahman
authors.affiliation: Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan, 430030, People's Republic of China. zhouyiwu@outlook.com.
authors.forename: Yiwu
authors.initials: Y
authors.lastname: Zhou
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D001344:Autopsy; D001934:Branchial Region / Q000002:abnormalities* / Q000000981:diagnostic imaging; D019465:Craniofacial Abnormalities / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D017577:Cutaneous Fistula / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D018450:Disease Progression; D004322:Drainage; D017809:Fatal Outcome; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D010608:Pharyngeal Diseases / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D012008:Recurrence; D012772:Shock, Septic / Q000382:microbiology; D013969:Thyroiditis, Suppurative / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
keywords: Branchial cleft anomaly; Immunohistochemistry; Neck abscess; Third branchial cleft fistula