Neck masses in children

A neck mass in a child is a common reason for a child to visit a pediatrician’s office or emergency department. Children may be born with a neck mass (this is called a congenital mass) or the mass may be a result of inflammation and less commonly due to a malignancy. The vast majority of neck masses in children are due to inflammation.

In order to understand the cause of a neck mass in your child it is important to know when the mass appeared, if there are any other associated symptoms like pain common with inflammation, difficulty breathing, fever, weight loss, night sweats, or vomiting may shed light on the cause. It is also important to know the rate at which the mass has grown (rapidly or slowly). Recent travel, a scratch by a cat or exposure to contaminated water may lead to the development of a neck mass.  Finally, the presence of constitutional symptoms such as.

The physician will examine the neck to see if there is one mass or several, the location of the mass, the consistency and size and whether it is easily moveable underneath the surface of the skin. All these may be clues to the nature of the mass.

Laboratory testing may include a blood count and a test to rule out tuberculosis organisms or a test for Bartonella, a disease caused by the scratch from a cat.

It is not uncommon for the doctor to order an imaging test like an ultrasound, CT or MRI to get more information about the type of mass present in the neck. Following imaging, your doctor may choose to performed a biopsy with a needle from the mass to try to get a sample of the tissue’s cells to help with the diagnosis. A needle biopsy is commonly either done in the office or under the guidance of ultrasound. Sometimes a biopsy may be necessary whereby a small incision may be made in the neck in order to obtain a larger sample of tissue when the needle biopsy does not provide enough information.

The most type of neck masses in children arise from a viral infection. In this case only supportive measures are necessary and the “mass” (actually lymph nodes) will generally disappear without the need for any treatment.

Sometimes masses are present from birth – these are called congenital and may include thyroglossal duct cysts, dermoid cysts, lymphangiomas, branchial cleft cysts, teratomas or congenital muscular torticollis.

Thyroglossal duct cysts are the most common mass to appear in the middle of the neck and are the second most common mass in childhood after a viral cause. The thyroglossal duct is a developmental remnant from the migration of the thyroid gland that begins its journey from where the back of the tongue is located to the bottom of the neck. When the tissue trail of the thyroid gland does not disappear a cyst is formed which may become infected because of its connection to the mouth (back of the tongue). It is typical for this cyst to rise and lower during swallowing. Definitive treatment of this condition is surgical removal commonly performed under general anesthesia. It is important to remove a thyroglossal duct cyst to prevent further infection and to reduce the rare chance of the duct becoming a cancerous growth.

Dermoid cysts are the second most common congenital mass to appear in the middle of the neck. They do not elevate with swallowing and do not get infected but because of their potential for enlargement, surgical removal is recommended.

Lymphatic malformations (cystic hygroma) are congenital malformations formed from blocked lymphatic ducts that fail to drain into veins. This results in multiple dilated sacs of lymph fluid. Up to 70% are present at birth and most are evident by 2 years of age. These masses are soft, compressible, non-tender and may extend to any part of the neck. Treatment consists of observation, injection of sclerosing agents, or surgical removal. Recurrence rate is high even following surgical resection.

During the development of various components of the head and neck, organs migrate from one place to another. During this movement, tissues leave a tubular tissue trails that normally disappear. If these tubes do not disappear they may result in the creation of tracts within the tissues called branchia cleft cysts. They may become infected because of the connection of deep tissues to the outside. These tracts may be located near the ear or earlobe, near the angle of the lower jaw or the main neck muscle called the sternocleidomastoid muscle.  Sometimes these tubular tracts may be located inside the mouth or throat.  The definitive treatment for all branchial cleft anomalies is usually surgical removal.

Masses in the child’s neck are less commonly due to a malignant growth like thyroid cancer, rhabdomyosarcoma, and Hodgkin’s and non-Hodgkin’s lymphoma. All can be fully treated with early detection.