Branchial cleft anomalies are among the most common causes of congenital anterior neck masses in the pediatric population. They present as epithelial-lined, single cysts. The definitive management is surgical excision. However, failure to remove the entire cyst and tract may lead to recurrence of the mass.

Unusual presentations of this condition may lead to incomplete excision if inadequately evaluated. There is a scarcity of material documenting atypical presentations of branchial cleft anomalies-- in particular, presentation as 2 distinct cysts in one region. In our literature search of PubMed, Google Scholar and HERDIN using the terms: "congenital mass," "branchial cleft cyst," and "multiple cysts," only 3 similar cases were found.

We report a case of a second branchial cleft anomaly presenting as a dumbbell-shaped mass (two cystic structures, connected by a tubular structure) in the right lateral neck, the subsequent management and outcomes.