The incidence of a second branchial arch sinus accounts for 26-60% of all existing congenital malformations deriving from the branchial apparatus. They are most usually detected between 14 months and 7 years of age, while their incidence during neonatal period and infancy accounts for 0.06% of all cases. The aim of this case study is to emphasize three rare characteristic features: the manifestation during neonatal period, the bilateral localization and the ultrasonographic diagnostic documentation. A 25 days old girl was admitted by her parents due to the presence of mucoid excretion from two small openings found on the neck. These openings were found bilaterally, between the mid and lower third of the anterior border of sternocleidomastoid muscle. Diagnosis was confirmed via ultrasonography. The patient underwent elective surgery during early infancy and both branchial fistulas were excised. Patient's postoperative course was uneventful. IN CONCLUSION: - in cases of a bilateral second branchial arch sinus, the branchio-oto-renal (BOR) or branchio-otic (BO) syndromes must be excluded; - ultrasound scan can be used for the thorough evaluation of the sinus anatomic course and the relationship with the adjacent anatomic structures; - rompt diagnosis and early therapeutic intervention, even during neonatal period, ensures an uneventful post-operation course.

1st Department of Pediatric Surgery Aristotle University of Thessaloniki General Hospital 'G Gennimatas' Thessaloniki Greece

Department of Internal Medicine General Hospital of Veria Veria Greece

Department of Radiology Aristotle University of Thessaloniki General Hospital 'AHEPA' Thessaloniki Greece

National Health Center of Kalambaka Trikala Greece

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