Bilateral branchial cleft fistula.

1. Department of Radiology, Kennemer Gasthuis, Haarlem, The Netherlands, 2. Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands Background: An 8-year-old boy was admitted to the pediatric department with two small lumps a few centimeters above the clavicles, medial from the mid-clavicular line, in a symmetrical arrangement (Fig. 1). Sometimes fluid was leaking out of the lump on the right side. During physical examination the lumps were suspected to be part of a branchial cleft abnormality. Medical history revealed microcephaly without a cause and bilateral hearing loss. The parents were consanguineous. Diagnostic tests for a genetic cause, in particular the branchio-oto-renal syndrome, were negative.