Figure 1. Photograph of the patient, showing lateral neck swelling A 26-year-old man who was otherwise healthy developed a painless swelling on the right side of the neck. During the 4 weeks after onset, the swelling increased rapidly in size, and a second smaller swelling developed on its superior aspect. The patient had no comorbid conditions and no constitutional symptoms. He denied a history of any preceding viral illness or head or neck trauma, and he had no history of international

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... He had never experienced any neck swelling in the past. On physical examination, there was a fluctuant, erythematous, nontender swelling along the anterior border of the right sternocleidomastoid muscle that was 4 cm ϫ 4 cm in area. No warmth of the overlying skin was present. A smaller swelling, 1 cmϫ 1 cm in area, was present on the superior aspect of the initial lesion (figure 1). The findings of a systemic examination were unremarkable. Fine-needle aspiration was performed. Pathological examination of the aspirate showed dense inflammatory exudate with epithelioid cells consistent with granuloma. The results of Gram staining were negative, and kinyon staining of the specimen did not reveal acid-fast bacilli. Bacterial, fungal, and mycobacterial cultures showed no growth. A CT scan of the neck was performed and is shown in figure 2 . What is your diagnosis?