The Child With a Neck Mass

Imaging Modalities

Potential imaging modalities include conventional radiographs, ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine. Conventional radiographs are used for evaluation of patients with stridor, suspected retropharyngeal abscess or adenoid hypertrophy. Ultrasound is ideal for optimally determining whether a mass is cystic or solid, as well as for assessing whether a node is suppurative and for guiding abscess drainage. In addition, it is the imaging modality of choice in children with suspected thyroglossal duct cyst, not only to prove the cystic nature of the midline neck mass but also to confirm the presence of a normal- appearing bi-lobed thyroid gland in the lower neck.^[1] Ultrasound is also ideal for evaluating patients with suspected fibromatosis colli.^[2,3] Ultrasound, CT, or MRI can be used for evaluating jugular vein patency in patients with suspected Lemierre syndrome (internal jugular vein thrombophlebitis and septic emboli secondary to pharyngotonsillitis).^[4,5] CT and/ or MRI are frequently used to evaluate the total extent of more diffuse diseases, including inflammatory, congenital, and neoplastic processes. Since imaging with MRI frequently requires sedation in children less than 6 or 7 years of age, CT of the neck is more frequently performed on these children. CT of the neck is also frequently performed in combination with CT of the chest/abdomen/pelvis in children with neoplasms such as lymphoma. CT is ideal for evaluating osseous erosion in children with suspected rhabdomyosarcoma, with MRI frequently performed as an adjunct in patients with suspected intracranial or intraspinal extension. MRI is the preferred method of imaging in children with suspected hemangioma of infancy, congenital vascular malformations, cervical neuroblastoma, and neurofibroma. Nuclear medicine imaging is frequently used in combination with CT and/or MRI for evaluation of children with neuroblastoma (I-123), lymphoma (gallium-67 citrate or fluorodeoxyglucose positron emission tomography [FDG-PET]), osteomyelitis (technetium [Tc]-99m-methylene diphosphonate [MDP], gallium-67 citrate) and other neoplasms.

Appl Radiol. 2005;34(8):8-22. © 2005 Anderson Publishing, Ltd.