Evaluating Neck Masses in Adult and Pediatric Patients

Gordon H. Sun, MD, MS


April 16, 2019

Initial Imaging Studies for Pediatric Neck Masses

Ultrasonography is the preferred initial imaging study for pediatric patients with neck masses.[4,5,6] Although accuracy is operator-dependent, ultrasonography is fast, inexpensive, widely available, and does not require sedation or exposure to ionizing radiation or contrast agents. Size, shape, location, vascularity, and consistency of the mass can all be determined by ultrasound.[5,6]

In this case, on the basis of the patient's history and examination findings, thyroglossal duct cyst is high on the differential diagnosis list, along with other midline lesions, such as dermoid cysts. Ultrasonography is used to not only to characterize the mass but also determine whether the thyroid gland itself is present and normal.[4,5,6] When evaluating patients for a thyroid mass, contrast-enhanced CT should be avoided because the contrast agent will interfere with current and potential future radioiodine treatment.[7] Moreover, because children are more radiosensitive than adults, contrast medium uptake may increase radiation-dose exposure to the pediatric thyroid by 12%-44%.[8]

After initial ultrasound studies, contrast-enhanced CT is valuable in children in whom cancer or a deep neck space abscess is suspected. However, CT poses several important risks, including nephrotoxicity and allergic reaction to the contrast agent, as well as exposure to ionizing radiation. MRI is useful for evaluating vascular malformations, though it is significantly costlier than CT or ultrasonography.[6] Young children often require sedation for MRI and CT studies, another key disadvantage relative to ultrasonography.[4,5,6] There is no meaningful role for plain neck films in the workup of pediatric neck masses.

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