A 68-year-old woman presented to the otorhinolaryngology clinic with a 5-year history of swelling in the neck and the recent development of discomfort when she swallowed. On physical examination, she had a soft and nontender mass in the midline of the neck that moved with protrusion of the tongue and swallowing. Examination with a nasopharyngoscope was normal, and ultrasonography of the neck showed a normal-appearing thyroid gland. Sagittal T2-weighted magnetic resonance imaging (MRI) of the neck revealed a hyperintense cyst in the midline, posterior to the hyoid bone and anterior to the thyroid cartilage (Panel A). T1-weighted MRI with gadolinium enhancement revealed a well-encapsulated cyst that contained fluid (Panel B). A thyroglossal duct cyst, the most common congenital cyst of the neck, was diagnosed. The patient underwent surgical removal of the cyst, and pathological examination showed no evidence of associated infection. The patient did well after surgery and had complete resolution of her presenting symptoms.