Neck Masses

Suspect a neoplasm when cervical lymphadenopathy does not improve with 6–8 weeks of appropriate therapy. The location of a mass (anterior neck, lateral neck, cheek) directs its differential diagnosis within three categories: inflammatory, congenital, or neoplastic. Cellulitis may rapidly progress to a dangerous abscess if left untreated.

Differential Diagnosis

• Lymphadenopathy
  –Inflammatory is most common pediatric neck mass
  –Viral or bacterial adenitis, mononucleosis, cat-scratch disease, tuberculosis, atypical mycobacterium
  –Granulomatous (sarcoid, etc.)
  –Lymphoma is most common neck malignancy
  –Kawasaki disease
  –Metastatic malignancy

• Deep neck abscess or cellulitis
  –Bacterial, atypical mycobacteria, cat-scratch disease, etc.
• Hemangioma
  –Most common benign neck neoplasm
  –Rapid growth, then spontaneous involution
• Vascular malformation
  –Lymphatic malformation (lymphangioma, cystic hygroma)
  –Venous malformation
  –Arteriovenous malformation
• Branchial cleft cyst
  –First (types I and II), second (most common), third
• Preauricular cyst
  –Anterior to tragus
• Thyroglossal duct cyst
  –Most common congenital midline mass
  –Elevates with swallowing
• Thyroid mass
• Ectopic thyroid
• Parathyroid mass
• Dermoid cyst
• Plunging ranula
• Teratoma
• Lipoma
• Thymic cyst
• Ectopic thymus
• Sternocleidomastoid (SCM) muscle tumor of infancy (congenital torticollis)
  –Fibrous tumors, unknown etiology
• Laryngocele
  –Abnormal dilatation of ventricle and saccule
• Salivary gland neoplasm
  –Parotid, submandibular
• Paraganglioma
  –Carotid body tumor, glomus jugulare, glomus vagale

Workup and Diagnosis

• History
  –Recent trauma or infection
  –Exposure to cats or tuberculosis
  –Weight loss

• Physical exam
  –Levels of the neck: I =submandibular, II =upper third of SCM, III =middle third of SCM, IV =lower third of SCM, V =posterior to SCM, VI =anterior neck
  –Infectious signs: Pain, redness, swelling
  –Systemic findings: Fever, hepatosplenomegaly

• Labs
  –CBC with differential: Atypical lymphocytes suggest EBV
  –PPD
  –EBV titers, monospot test
  –HIV test, if suspected by history
• Fine needle aspiration (FNA) biopsy
  –Can differentiate abscess from cellulitis
  –Cytology may diagnose pathology of soft tissue tumor
• X-rays
  –Lateral neck useful screen for retropharyngeal abscess
• CT scan with contrast (abscess shows low-density center with rim enhancement) or MRI
• Ultrasonography
  –For midline neck masses, may be used to confirm presence of a normal thyroid
  –Also differentiates abscess from cellulitis

Treatment

• Oral antibiotics for infected neck masses
  –IV antibiotics if poor response
• Abscess requires incision and drainage (I&D)
  –Send contents for Gram stain and culture
• Cat-scratch disease and atypical mycobacteria self-limiting, but take months to resolve
• Congenital cysts and masses: Excision
  –If infected, delay excision until infection clears
• Hemangiomas treated only if obstruct breathing or feeding, or cause thrombocytopenia or cardiac failure
  –Excision, laser ablation, steroids, interferon
• Lymphatic malfomations are benign; surgical debulking with sacrifice of normal tissues; may recur
• SCM tumor of infancy (congenital torticollis) usually resolves with physical therapy only
• Cold abscess (no fever or pain) requires I&D
• If airway obstructed, intubate
  –Severe obstruction may require tracheostomy

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Neck symptoms

Read excerpts from these other book chapters related to Neck symptoms:

Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Neck symptoms

• Back to symptom: Neck symptoms: Introduction (review 620 causes)
• Next Book Extract About Neck symptoms: NECK PAIN (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Neck symptoms

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: NECK PAIN (Differential Diagnosis in Primary Care)

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