General Management of Pediatric Neck Masses
General management of neck masses
Dr. Rahul Gupta
-
1st Step: always go through the ABCs and ensure that the patient is adequately protecting their airway
-
Acute bilateral lymphadenopathy: consider viral infections à typically self-limited and symptomatic control
-
If crosses the jaw: consider parotid gland involvement, raising suspicion for mumps
-
Unilateral lymphadenopathy: <1 cm does not need treatment; between 1-3cm; initiate antibiotics to treat Group A strep and Staph; >3cm raise suspicion for malignancy à observe and follow-up
-
Fluctuant mass concerning for abscess: Often respond to antibiotics alone. Needle aspiration may be helpful to avoid incision in cosmetically important areas. If not resolving after 2 weeks, may require evaluation by US and I&D
-
Subacute to Chronic lymphadenopathy:
-
Consider TB based on exposure à Mantoux testing to differentiate strains
-
Consider Cat-Scratch Disease based on history à typically self-resolving
-
Consider Toxoplasmosis based on exposure à dx serologically with antibody titers à treatment not needed in healthy individuals
-
Congenital masses:
-
Thyroglossal duct (midline) à excision if not infected
-
Dermoid cyst (midline) –> surgical excision
-
Branchial cleft cyst (anterior triangle) à oral antibiotics if infected followed by excision
-
Lymphangioma (posterior triangle) à injection of sclerosing agents vs surgical excision
-
Benign Neoplasms:
-
Hemangiomas à typically resolve spontaneously; if rapid growth à beta blockers, steroids, and possible surgical excision
-
Neurofibromas and schwannomas
-
Fibromatosis Colli: Stretching and physical therapy
-
Malignant Neoplasms à excisional biopsy + ENT consult
-
Lymphoma: supraclavicular mass
-
Rhabdomyosarcoma: large painless mass
-
Neuroblastoma
-
Thyroid cancer
-
Metastatic disease
-
Torsiglieri AJ Jr, Tom LW, Ross AJ III, et al: Pediatric neck masses: guidelines for evaluation. Int J Pediatr Otorhinolaryngol 16: 199, 1988. [PMID: 3235286]
-
Gosche JR, Vick L: Acute, subacute, and chronic cervical lymphadenitis in children. Semin Pediatr Surg 15: 99, 2006. [PMID: 16616313]
-
Carbone PN, Capra GG, Brigger MT: Antibiotic therapy for pediatric deep neck abscesses: a systematic review. Int J Pediatr Otorhinolaryngol 76: 1647, 2012. [PMID: 22921604]
-
Lee J, Fernandes R: Neck masses: evaluation and diagnostic approach. Oral Maxillofac Surg Clin North Am 20: 321, 2008. [PMID: 18603194]
-
Swischuk LE, John SD: Neck masses in infants and children. Radiol Clin North Am 35: 1329, 1997. [PMID: 9374993]