Intermittent Suprasternal Neck Mass Caused by Herniation of Ectopic Thymus: Report of Two Cases

Document Type : Case Report


1 Department of Otorhinolaryngology, Head and Neck Surgery, University Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.

2 Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.


Ectopic thymus is an uncommon cause of neck masses in children that frequently present as lateral cervical swelling especially on the right side.
Case Report:
We report two cases with atypical clinical presentation of ectopic thymus and superior herniation of normal thymus. Both of the patients manifested as intermittent midline mass at the suprasternal region during Valsalva manuevre. Unique ultrasound features with the location along the thymic descent together with dynamic assessment of the organ movement were essential to reach the correct diagnosis. Conservative approach was considered in these patients considering the necessity of thymus in the process of puberty.
High index of suspicion is of utmost importance when encounter patient with similar clinical manifestation to avoid unnecessary diagnostic modalities and surgeries. Accurate diagnosis will also alleviate parents’ anxiety.


  1. Ozel A, Akdur P, Celebi I, Karasu R, Yilmaz B, Basak M. Ectopic cervical thymus as a rare cause of pediatric neck mass: the role of ultrasound and MRI in the diagnosis. Case report. Medical Ultrasonography. 2015;17(2):248.
  2. Costa N, Laor T, Donnelly L. Superior Cervical Extension of the Thymus: A Normal Finding That Should Not Be Mistaken for a Mass. Radiology. 2010;256(1):238-242.
  3. Su S, Hess T, Whybourne A, Chang A. Intermittent midline suprasternal neck mass caused by superior herniation of the thymus. Journal of Paediatrics and Child Health. 2014;51(3):344-346.
  4. Chu W, Metreweli C. Ectopic thymic tissue in the paediatric age group. Acta Radiologica. 2002; 43(2): 144-146.
  5. Hegde K, Suneetha P, Pradeep P, Kumar P. Asymptomatic Thymic Cyst Appearing in the Neck on Valsalva: Unusual Presentation of a Rare Disease. Journal of Clinical Imaging Science. 2012; 2:11.
  6. Tovi F, Mares A. The aberrant cervical thymus. The American Journal of Surgery. 1978; 136(5): 631-7.
  7. Prasad TR, Chui CH, Ong CL, Meenakshi A. Cervical ectopic thymus in an infant. Singapore medical journal. 2006 Jan;47(1):68.
  8. Nasseri F, Eftekhari F. Clinical and Radiologic Review of the Normal and Abnormal Thymus: Pearls and Pitfalls. RadioGraphics, 2010; 30(2), 413–428. doi: 10.1148/rg. 302095131 
  9. Ünal E, Düzkalır H, Kurt-Güney S, Işıldak E. Aberrant cervical thymus and the role of ultrasonography: a case report. The Turkish Journal of Pediatrics. 2016;58(2):230.
  10. Schloegel L, Gottschall J. Ectopic cervical thymus: Is empiric surgical excision necessary? International Journal of Pediatric Otorhinolaryngology. 2009;73(3):475-9.