A 6-year-old girl is referred to you by her pediatrician complaining of a pain in her throat and presenting with an anterior cervical midline mass for several weeks. After a course of antibiotics the inflammation and erythema resolved but the mass still persisted. The mother is concerned. She remembers a time when the child was 3-years-old complaining of similar symptoms, but then it spontaneously resolved. Physical chest exam is normal but the mass appears to rise upward when the girl sticks out her tongue. What is the most common diagnosis?

Embryologically the thyroglossal duct cyst (Figure below) runs from the pyramidal lobe of the thyroid to the foramen cecum at the base of the tongue. It needs complete excision including part of the hyoid bone to avoid recurrence. An ectopic lingual thyroid is located at the base of the tongue and virtually never seen in the above described anterior midline location. Cervical lymphadenitis needs to be ruled out and a several microbial stains performed if an abscess develops. Masses caused by atypical mycobacterial do not respond to antibiotic therapy and need to be excised. Brachial cleft remnants are almost always seen in the alter neck and divided in several types depending on their branch origin. They, however, can also get infected in manifest sometimes in form of a lateral neck abscess.Thyroglossal cyst and duct course through the hyoid bone to the foramen cecum of the tongue