Evaluating Neck Masses in Adult and Pediatric Patients

Gordon H. Sun, MD, MS

Disclosures

April 16, 2019

Cervical Lymphadenopathy in Children

This scenario is probably familiar to most clinicians who treat children. Although the differential diagnosis of cervical lymphadenopathy is extensive, infection is far and away the most common cause in children.[3] In fact, an estimated 80%-90% of pediatric neck masses are benign, and the majority of these have an infectious etiology.[4] The constellation of fever, pain on palpation, rapid onset of the mass, and recent symptoms of an upper respiratory tract infection strongly suggest an infectious etiology. The most common infectious etiologies of cervical lymphadenitis are Staphylococcus aureus and group A Streptococcus.[5]

Unresolved, Recurrent Neck Mass in a Pediatric Patient

A 12-year-old girl was brought to her pediatrician by her parents for reevaluation of a midline neck mass that, as far as the patient and her parents could recall, "had been present for a long time." The child had been evaluated 2 years earlier by another clinician who, at that time, informed the girl's parents that the neck mass was benign and did not require surgical intervention.

The patient's parents stated that the neck mass had remained nonpainful and unchanged until approximately 1 year ago when she developed a cold, at which time it had become swollen and tender to palpation, with associated redness. The parents again sought care for their daughter, this time at a local emergency department (ED). Although the ED records were inaccessible to the clinician, according to the parents the child had an extensive evaluation to rule out cancer or infection, the mass was drained, and she was discharged home with a short course of antibiotics and instructions to follow up with her pediatrician. Despite this intervention, the neck mass eventually returned to its current size, prompting the parents to seek reevaluation.

At this visit, both the child and her parents deny any recent fevers, dyspnea, dysphonia, discomfort, difficulty with swallowing, or constitutional symptoms. Her history was unremarkable. She had no surgical history or family history of cancer; was not taking any medications; and had no known drug, food, or environmental allergies.

On exam, the patient was well nourished and well appearing, with normal vital signs. No stridor or dysphonia was noted. Pertinent findings on the head and neck examination included a rounded, nontender mass on the anterior midline neck measuring 2 x 2 cm, with slight scarring of the skin overlying the mass. The mass moved upward when the patient swallowed. No intraoral lesions were seen or palpated, and the tongue was fully mobile. The remainder of the examination was normal.

The pediatrician planned to obtain imaging and selected laboratory studies on the basis of the patient's history and physical examination findings.

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