Neck masses

Chapter 32 NECK MASSES


Kevin Haggerty



General Discussion


Pediatric neck lesions may be divided into three categories: congenital, inflammatory or infectious, and neoplastic. Although most adult neck masses are malignant, 90% of pediatric neck lesions are benign. Given the diverse nature and etiologies of these lesions, no definitive or algorithmic approaches to neck masses have been established. Physicians must recognize that most of these lesions are benign and use a careful history and physical examination to guide their approach. The rapidity of onset, associated symptoms, family and social history, age of the patient, and physical findings are essential in the formulation of a differential diagnosis.


Palpable cervical nodes are present in 40% of infants. When all age groups are considered, about 55% of children have palpable nodes that are not associated with infection or systemic illness. Lymphoid tissue proliferates until puberty, at which time lymphoid mass is double that of adult values. Lymph nodes smaller than 3 mm in diameter are normal. Cervical nodes up to 1 cm in diameter are normal in children younger than 12 years of age. Small nodes in the anterior cervical triangle are usually benign.


The presence of a painless mass present at birth or identified shortly after birth is consistent with a lesion of congenital origin. Rapid enlargement often occurs with malignant lesions, inflammatory masses, and congenital masses such as thyroglossal duct cysts, branchial cleft cysts, and lymphangiomas. Acute or subacute enlargement, tenderness, and overlying erythema or fluctuance of the cervical lymph nodes, especially if temporally related to a recent upper respiratory tract infection, suggest an inflammatory origin. Cystic lesions are usually pharyngeal cleft remnants and vascular malformations, whereas solid lesions are generally inflammatory or neoplastic. Systemic symptoms may suggest a malignant or infectious process. Malignant lesions tend to be painless, solid, and associated with other systemic manifestations. Malignancy should be considered in any patient with a solitary posterior cervical mass. Supraclavicular masses are most likely to represent lymphoma.






Jun 18, 2016 | Posted by in PEDIATRICS | Comments Off on Neck masses

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