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]