Aboud Journal of Medical Case Reports 2011, 5:220 http://www.jmedicalcasereports.com/content/5/1/220 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Respiratory difficulty caused by an ectopic brain tissue mass in the neck of a two-month-old baby: a case report Mohammed J Aboud Abstract Introduction: Neuroglial heterotopia, heterotopic brain tissue, or differentiated neural tissue outside the cranial vault is uncommon, and these anomalies most commonly occur in the nasal cavity. Case presentation: We report a case of rare pure cystic heterotopic brain tissue in a two-month-old Caucasian baby girl that presented as a large cystic neck mass and was confused with a cystic hygroma. Her mother reported a progressive increase in the size of this swelling and mild respiratory difficulty when the girl was sleeping. A computed tomography scan of the brain and neck showed a large heterogeneous mass extending from the base of the skull to the left submandibular region; a cystic component was also noted. Our patient under went total excision of the cystic mass and prevention of airway obstruction by a left submandibular approach. The final gross pathology diagnosis was heterotopic brain tissue. Conclusions: Pure cystic neck heterotopic brain tissue lesions are very uncommon, and a preoperative diagnosis of this lesion is difficult. Brain heterotopia is a rare, benign condition that should be considered in the differential diagnosis of the neonatal head and neck mass. Introduction Neuroglial heterotopia, heterotopic brain tissue, or dif- ferentiated neural tissue outside the cranial vault is uncommon, and these anomalies most commonly occur in the nasal cavity [1,2]. In rare instances, neuroglial heterotopia in the neck has been reported [3-5]. Pre- vious reports of these cases have shown only computed tomography (CT) images of neuroglial heterotopia pre- senting as a low-attenuation mass with some area of focal cystic formation [3-6]. The most common location of heterotopic brain tissue is in the nasal region [7,8]. However, heterotopic brain tissue has also less com- monly been reported to occur in other sites, such as the pharynx, lung, orbits, palate, tongue, cheek, lip, and neck [9]. To the best of our knowledge, only five or six cases of heterotopic brain tissue with a cystic pattern occurring in the neck have been reported [9-11]. We report a case of uncommon pure cystic heterotopic brain tissue in a two-month-old baby girl that presented Correspondence: mohammedabud@yahoo.com Pediatric Surgery Unit, The Maternity and Child Teaching Hospital, Al- Qadisiya, Iraq as a large cystic neck mass and was confused with a cys- tic hygroma [12]. Case presentation A two-month-old Caucasian baby was admitted to our pediatric surgical ward because of swelling in her left neck region present since birth. She was noted by her mother to have a growing left-sided neck mass and mild respiratory difficulty when sleeping. There was no asso- ciated odysphonia or dysphagia. No neck stiffness and no upper respiratory tract infection had been noted in the few days before presentation. Her prenatal history was unremarkable. Our patient experienced snorting, nasal flaring, and an inability to feed on initial evalua- tion. A physical examination revealed no gross craniofa- cial abnormalities; our patient was a healthy baby with a large (6 cm × 8 cm) palpable mass in the left neck extending from the upper neck to the supraclavicular fossa. The mass was soft, compressible, non-tender, and fixed. There were no associated changes in the overlying skin. The remainder of the physical examination was normal. A chest radiograph showed a mass lesion in the © 2011 Aboud; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.