The following are the most common categories of pediatric neck masses and three examples of each. The most common categories of pediatric neck masses include congenital, inflammatory infectious, inflammatory non-infectious, and malignant neck masses. The differential diagnosis is based on the location of the mass in the neck.
Congenital Neck Masses
Thyroglossal Duct Cyst (TGDC): A thyroglossal duct cyst (TGDC) is the most common congenital neck mass in children. It is a fluid filled mass located in the midline of the neck that is usually not found until age 2 but has been present from birth (congenital).
Dermoid cyst: Dermoid Cysts are the second most common midline neck mass. While they commonly are seen in the neck they can occur throughout the body. They can occur shortly after birth and can get bigger. They originate in the dermis and don’t get infected. The treatment is surgical excision.
Lymphatic Malformation: Lymphatic malformations (LMs) are cystic masses that can occur in the head and neck from lymph fluid and failure of lymphatic sacs to form channels that should drain into our veins. The result are large, soft, compressible masses that grow anywhere in the neck. They can get inflamed and can grow. Sometimes they can cause airway compression and cosmetic deformities.
The two most common lymphatic malformations are macrocystic and microcystic. Macrocystic LMs, also known as cystic hygromas, are in the neck and don’t typically extend into the mouth. They are well circumscribed in larger clusters. They can be treated with surgery or with injecting a scarring agent, a treatment called sclerotherapy. Microcystic lymphatic malformations form smaller cystic structures and tend to infiltrate tissues more. They tend to occur higher in the head and neck, often into the oral cavity and tongue. They are more difficult to treat.
Branchial Cleft Anomalies: Branchial Cleft Anomalies are the result of incomplete closure of clefts or pouches in our head and neck region during embryological development. This can form in a combination of sinus tracts, fistula tracts, or cysts.
Muscular Torticollis: Congenital Muscular Torticollis (CMT) is a result of a firm, fibrous mass in the body of the neck muscle called the sternocleidomastoid muscle. The mass is fibrosis of a hematoma in the body of the muscle. The hematoma is thought to occur during birth. The mass causes the head to tilt towards the side of the mass and the chin to rotate to the opposite side.
Teratoma
Arteriovenous/venous malformation
Inflammatory Infectious Neck Masses
Viral lymphadenitis
Bacterial lymphadenitis
Cat-Scratch Disease
Infectious Mononucleosis
Atypical Mycobacterium
Inflammatory Non-Infectious Neck Masses
Plunging Ranula
Pilomatrixoma
Kawasaki’s
Reactive lymphadenopathy
Malignant Neck Masses – Neoplasms
Lymphoma
Rhabdomyosarcoma
Salivary Gland Tumors
Thyroid Carcinoma
Location of Neck Masses
- Posterior triangle: lymphoma, lymphadenitis, cystic hygroma, reactive LN
- Supraclavicular: lymphoma, lymphadenitis, cystic hygroma
- Anterior: thyroglossal duct cyst, dermoid cyst, lymphadenopathy
- Lateral: branchial cleft cyst, lymphadenitis, sialadenitis, cystic hygroma, cat-
- scratch, atypical mycobacterium, reactive LN
- Preauricular: preauricular cyst, atypical mycobacterium, cat-scratch
- Cystic hygroma and lymphadenitis crosses all boundaries!