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AJNR - American Journal of Neuroradiology

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Fluoroscopic and CT Fistulography of the First Branchial Cleft

J. Whetstone^a, B.F. Branstetter, IV^a,b and B.E. Hirsch^a

^a Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa
^b Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pa

View larger version (96K): [in a new window]   Fig 1. Fluoroscopic fistulogram of a first branchial cleft anomaly. Lateral (A) and frontal (B) projections demonstrate the course of the fistulous tract from the skin overlying the angle of the mandible (black arrow) to the external auditory canal (white arrow). The external auditory canal is filled with contrast (E). Note the small filling defect (arrowhead) in the midportion of the anomaly. The angiocatheter remains in position on the lateral projection (curved arrow).

View larger version (77K): [in a new window]   Fig 2. CT fistulogram. Axial CT images (kV = 120, mA = 120, thickness = 1.25 mm) without intravenous contrast are shown from superior (A) to inferior (F). Contrast material is seen within the first branchial cleft tract (arrow). The relationships of the tract to the parotid gland and the retromandibular vein (arrowhead) are well defined for ease of surgical planning. A, Contrast is seen spilling into the external auditory canal (E). B, Just below the external auditory canal, the tract passes into the parenchyma of the parotid gland. C, The tract traverses the gland, running superficial to the retromandibular vein. D, Streak artifact from dental amalgam degrades the image as the tract passes through the parotid capsule into the subcutaneous fat. E, The tract continues inferiorly within the subcutaneous fat. F, The tract exits the skin at the level of the mandibular angle.