Approach To Neck Asses Flashcards
What are the key aspects of the history when assessing a neck mass in a child?
• Duration: Present from birth (congenital lesion) or developed over time
• Speed of development: Slow-growing (e.g., TB node) vs. rapid (e.g., bacterial lymphadenitis)
• Pain: Tenderness may suggest infection
• Associated symptoms: Fever, night sweats, weight loss, chronic cough, or other nodes (indicating a systemic process)
What are some possible causes of a neck mass in children?
• Congenital lesions
• Infection (e.g., TB, bacterial lymphadenitis)
• Systemic processes (e.g., lymphoma)
• Tumors
What is the first step in assessing a neck mass in a child?
Start with a thorough history, followed by a general and focused clinical examination.
Why is it important to assess the neck mass carefully?
A neck mass may be a sign of a generalized process like TB or lymphoma, requiring careful evaluation.
What general examination findings are concerning when assessing a neck mass in a child?
• Other sites of lymphadenopathy
• Wasted child
• Pallor
How does the site of a neck mass help in diagnosis?
• Central or lateral location can provide clues to the nature of the mass.
• A mass in the oral cavity may suggest a different pathology.
What does the size of a neck mass indicate in a child?
Smaller nodes are often reactive, requiring treatment of the underlying condition.
What does the consistency of a neck mass suggest?
Firm to rubbery nodes may indicate serious underlying conditions.
What does the mobility of a neck mass tell you?
• Small mobile nodes are common and often benign.
• Fixed, firm nodes require investigation.
• Thyroglossal cysts move on tongue protrusion.
What does tenderness of a neck mass suggest?
• Tenderness implies an infective process.
What other clinical signs should be examined in a child with a neck mass?
Examine the whole region, including the oral cavity, for signs like tonsillitis, dental problems, or scalp dermatitis, which may indicate a reactive node.
What investigations might be needed to assess a neck mass?
Blood work and radiological investigations may be required, guided by the presumed diagnosis.
What is the management approach for bacterial lymphadenitis in children?
A trial of antibiotics is usually sufficient. Investigations should be done if the mass does not improve.
What should be considered if a neck mass may be caused by TB or a non-benign lesion?
Full TB and/or blood workup may be needed, along with a chest X-ray (CXR) or ultrasound of the mass.
What investigations are needed for congenital neck lesions?
Ultrasound is often required as part of the surgical planning.
What is the first-line imaging for a neck mass in children?
Neck ultrasound is the first-line imaging.
When is MRI indicated in the assessment of a neck mass?
MRI may be used to assess the extent of lesions such as lymphatic malformations.
