The paper describes the case of a 3-year-old girl who was repeatedly hospitalised for a swelling on her neck, which showed a scarce response to the antibiotic therapy, was significantly recurrent and was associated with fever and a remarkable increase in the inflammation indexes. On each admittance the clinic was characterised by a strict correlation between the onset of the swelling and dysphagia and dysphonia that suggested a malformation of the branchial apparatus. The final operatory and histological diagnosis was that of an anomaly of the third and fourth branchial pouches, associated with pyriform sinus fistulae.