Causes of neck masses and swelling can be broken down into three categories: inflammatory, congenital, and neoplastic; though some may be in more than one category, such as teratoma/dermoid cyst, or infected congenital lesions such as an infected branchial cleft cyst. Clinicians make the majority of diagnoses by taking a careful history and performing a physical examination. Although most neck masses in children are due to inflammatory conditions, followed by congenital conditions, the clinician must be wary of more ominous causes, such as malignancy. Although 80% to 90% of head and neck masses in children are benign, 5% of all malignancies in children are in the head and neck area.

• Carefully assess factors such as age; onset, duration, and progression of symptoms; presence or absence of systemic symptoms including fever, fatigue, weight loss, night sweats, joint pain, or swelling; recent upper respiratory tract infection (URI) or sick contacts; animal or food contacts, especially animal bites or scratches or exposure to uncooked meats and unpasteurized milk; immunization status, immunocompromised; recent travel; and medications.

• Acute or subacute enlargement, pain, erythema, fluctuance, and/or recent URI suggest inflammatory conditions.

• Lesions present since birth or shortly thereafter are likely congenital. Think of underlying anatomic anomaly when there is recurrent infection in the same location.

• Make note of size, location, including sidedness, consistency, mobility, pain, overlying skin changes, and whether the swelling is localized to the neck region or more generalized as in diffuse adenopathy.

• Examine all other nodes and complete a full HEENT (Head, Eyes, Ears, Nose, and Throat) examination, including an oropharyngeal, dental, face, scalp, ear, and eye exam. Perform a general examination, including cardiovascular, pulmonary, abdominal, and extremities examination.

• Consider serial assessments of the neck mass or swelling, ideally performed by the same physician each time.

• Note some diagnosis-specific findings on examination, including the following:

  • Viral adenopathy may be seen in association with findings such as rash, pharyngeal erythema, oral mucosal vesicles, or conjunctival injection.

  • Cervical adenitis is usually rapid in onset, unilateral, tender, warm, and red. The child may have fever, fatigue, and irritability.

  • Patients with bartonella infection usually only have one enlarged node in the area that drains the site of inoculation. A papule or pustule may have been seen at the inoculation site approximately 2 weeks before lymphadenopathy.

  • Branchial cleft cysts are usually deep to the upper third anterior border of the sternocleidomastoid, painless, and with clear drainage from the opening along the sternocleidomastoid. The tract may be palpable.

  • Thyroglossal duct cysts are soft, smooth, nontender, and in the midline, usually below the level of the hyoid. Only 20% are above and 15% are at the level of the hyoid. They typically do not have a primary external opening unless infected. Look for upward movement of the mass with swallowing or tongue protrusion, due to connection with the base of the tongue.

  • Dermoid cysts are usually mobile, though they may adhere to underlying bone, and be nontender. They may be in the midline and confused with thyroglossal duct cysts. Dermoid cysts can be distinguished by depth in that they are generally superficial, by the presence of sebaceous material, and by anatomy as they typically have no connection to the hyoid or tongue.

  • A soft, spongy, compressible swelling with a bluish hue may be a venous malformation.

  • Cystic hygromas can be as small as a few millimeters but are often much larger. They are discrete, soft, nontender, and mobile.

  •

Stay updated, free articles. Join our Telegram channel

Join