Introduction Embryological remnant of migratory path of thyroid from the tongue base due to arrested endodermal migration from the pharyngeal floor usually located in the midline neck often close to hyoid bone often go unnoticed until they get infected in association with an upper respiratory tract infection histology of an infected cyst follicular cells surrounding colloid admixed with a neutrophilic infiltrate Presentation Physical exam palpation of midline mass moves with protrusion of the tongue and swallowing Differential Diagnosis Persistent cervical sinus (pharyngeal cleft cyst) differentiating factor lateral neck mass anterior to the sternocleidomastoid muscle does not move with protrusion of the tongue and swallowing Treatment Surgical excision of mass