CH 5 Pediatric Neck Flashcards
Thyroid development
develops in the floor of the pharynx at the base of the tongue and descends into the neck. The thyroid gland is connected to the tongue for a short time by the thyroglossal duct. this duct degenerates and disappears.
pyramidal lobe
is a persistence of the inferior portion of the thyroglossal duct.
Congenital Hypothyroidism
usually related to a developmental anomaly such as ectopia or dyshomonogenesis (enzyme defect)
*children with congenital hypothyroidism have a condition called cretinism.
Ectopic thyroid gland
thyroid located along the normal route of descent from the tongue.
*most common Lingual thyroid. incomplete descent of the thyroid, thyroid tissue remains high in neck.
accessory thyroid gland
thyroid tissue may appear in the thymus gland. Tissue is functional, but insufficient to maintain normal thyroid function
goiter
non-specific general term for an enlarged thyroid, many causes.
Thyroid anomalies
congenital hypothyroidism
ectopic thyroid gland
accessory thyroid gland tissue
goiter
Thyroiditis
graves disease
hashimotos thyroiditis
DeQuervain’s
Bacterial thyroiditis (acute suppurative)
Graves disease
thyroid hyperplasia and hyperfunction when occuring in children. more common in adolescent girls.
gland is heterogenous due to infiltration of lymphocytes and multiple blood vessels.
Graves symptoms:
tachycardia, exophthalmos, and enlarged thyroid.
may also be associated with myasthenia gravis, pernicious anemia, or adrenal insufficiency.
Graves disease sono
“thyroid inferno” lights up of CFD, diffuse neck lymphadenopathy may also be present. an enlarged, lobulated, hypoechoic, inhomogenous gland.
Hashimotos Thyroiditis
chronic autoimmune condition where lymphocyte infiltration of the gland occurs.
common cause of hypothyroidism.
Hashimotos sono
enlarged, coarse gland along with increased vascularity of the gland during a hypothyroid event.
disease eventually casuses the thyroid to progress to a small atrophied gland.
DeQuervains thyroiditis
is an uncommon form of subacute thyroiditis casued by a viral infection
Bacterial thyroiditis (acute suppurative)
rare and usually due to a staph infection.
usually seen in association with a third/fourth branchial arch anomaly on the left.
Thyroid carcinoma
uncommon in children, thought to be associated with irradiation of head or neck.
Papillary carcinoma
Follicular carcinoma
Medullary carcinoma
Papillary carcinoma
majority of thyroid cancers.
most common identifying feature is micro-calcifications.
lymph nodes are present in >50%
metastasizes through the lymphatics
Follicular carcinoma
metatasizes through the bloodstream.
encapsulated
Medullary carcinoma
occurs with MEN (multiple endocrine disorders)
associated: pheochromocytoma’s, parathyroid hyperplasia (secretes calcitonin), and GI neuromatoses.
tumors metastasize early
Parathyroid glands
calcium sensing organs, usually dont see.
anomalies are extremely rare in children and usually secondary to severe renal disease.
3 types of neck masses
congenital
inflammatory
neoplastic
Congenital masses of neck
Thyroglossal duct cyst branchial cleft anomalies cystic hygroma congenital torticollis (fibromatosis colli) cervical lymphadenopathy cervical teratoma salivary cyst
Thyroglossal duct cyst
most common superficial midline neck mass.
a remnant of the thyroglossal duct.
50% appear in children less than 10 years old, asymptomatic
common in adolescents following an upper respiratory infection.
inferior to hyoid bone, and present as painless sweling, with and enlarging and mobile mass. cystic lesion, may recur.
Branchial cleft anomalies
remnant of embryonic development. 4 paired branchial clefts.
present as solitary, mostly cystic mass on the lateral aspect of the neck at the angle of the mandible under the sternoclediomastoid muscle (SCM)
may be connected to the mouth and become infected
cystic hygroma (lymphatic malformation)
congenital lymphatic malformation, failure of developing lymphatics to drain into the veins.
associated with: Turners, downs, klinefelter syndromes and trisomy 18 and 13.
70% in neck and face
painless compressible mass, often complex and contain multiple septations.
Congenital torticollis (fibromatosis colli)
shortening and fibrosis of the SCM. pulls head and neck to affected side.
associated: developmental dysplasia of the hip and tibial torsion.
sono: dense mass of tissue is seen in the SCM.
Cervical lymphadenopathy
may be normal in children due to URI’s, rare in infants
causes: Epstein-Barr virus, lymphadenitis, cat-scratch disease, and kawasaki’s disease.
cervical teratomas
rare. most are benign.
sono: multilocular heterogeneous mass. large infiltrative cystic or solid masses in the anterior or lateral neck. typically found prenatally
salivary glands
exocrein glands which secrete saliva and amylase.
simple salivary gland cysts are rare; cysts we normally see are mucous retention.
Parotid gland
round or oval shaped and largest gland, lies anterior to ear.
- most commonly involved with disease in children
- stensen’s duct drains the parotid into the oral cavity (abnormal to see stensen’s duct)
submandibular gland
seen below jaw. * triangular in shpae and less echogenic than parotid gland. floor of mounth, stone formation
anterior facial vein runs in the anterosuperior border and the lingual artery borders the medial portion.
*wharton’s duct runs through the medial part of the gland.
sublingual gland
difficult to identify.
*cysts occurring in the sublingual gland are called ranulae. these are mucous retention cysts, result from obstruction of sublingual gland/duct
Sialadenitis
inflammation of the salivary glands. parotid and submandibular glands most affected.
acute: secondary to viral or bacterial infections: mumps, mono, CMV (most common)
chronic: HIV, sjogren’s, granulomatous processes
enlargement of salivary glands may be due to: inflammation from parotitis or lympadenitis
*mumps is the most common cause of parotitis
Juvenile recurrent sialadenitis (parotitis)
* most common cause of parotid swelling in children in developed countries. unknown etiology (a lot caused by mumps) more common in boys, present around 3-6 years ceases at puberty.
Juvenile recurrent sialadenitis (parotitis) sono
enlarged parotid with multiple round hypoechoic areas measuring 2-4 mm are seen, which represent lymphocytic infiltrate. some hypervacularity is evident.
treat with antibiotics.
acute sialadenitis
infection of salivary gland caused by a virus or bacteria. more common in parotid gland and peaks at 2-14 years. usually due to staph or strep.
sono: heterogeneous gland with dilated ducts, small punctate echogenic areas and multiple hypoechoic areas.
sialectasis
dilatation of a salivary duct usually due to a chronic infection.
sialolithiasis
stones in salivary glands, not common
90% occur in submandibular gland 10% in parotid gland
Neck neoplasms (benign or malignant)
Benign: hemangiomas (vascular, most common in parotid) cystic hygromas Malignant: rhabdomyocarcoma primary lymphoma leukemia (infiltrative) Mets
Rhabdomyocarcoma
most common pediatric sarcoma, poor prognosis
40% occur in neck
can arise from any muscle
parotid gland may be involved by direct extension
primary lymphoma
usually MALToma- origin from mucosa associated lymphoid tissue.
at risk: sjogrens, HIV, autoimmune dz
(secondary lymphoma is rare but more common in the parotid)
Leukemia (infiltrative)
rare
Mets (neck)
rare
neuroblastoma, emlanoma, thyroid ca, squamous cell ca
Parinaud oculoglandular syndrome
due to CMV or cat-scratch disease.
conjunctivitis and ipsilateral parotid or periauricular adenopathy.
bronchogenic cyst
usually mediastinal, foregut cysts, esophageal cysts and laryngoceles.
cysts of vallecula
congenital or acquired, composed of retained secretions in the mucous glands and occur in the pharyngeal wall.
can cause upper airway obstructions, need to be removed
Dermoid and Epidermoid
Dermoid cysts: contain ectoderm and mesoderm cells
Epidermoid lesions: contain ectoderm cells only
Infantile hemangioma (head/neck)
small lesion 2-6 weeks after birth, strawberry hemangioma
90% resolve by 9 years old.
if more than 5 lesions, u/s liver due to risk of high-output cardiac failure
Congenital hemangiomas
rare, fully formed at birth.
RICH- rapid involuting congenital hemangioma
resolve by 1 year of age
NICH- non-involuting congenital hemangiomas
suspected if does not involute by 4-6 months
Port wine stains
capillary malformation associated with sturge-weber syndrom and klippel-trenaunay syndrome.
present at birth, darken with age
90% unilateral
they can affect the cutaneous distribution of the opthalmic and maxillary trigeminal nerve.
Venous malformations
grow with child and do not involute, becoming larger at puberty. bluish, compressible, soft skin lesion.
Lymphoma (neck mass)
can cause masses in head and neck.
- Hodgkin’s lymphoma occurs in adolescents
- non-hodgkins is more common in the 2-12 year old age group.
neuroblastoma (head/neck)
can metastasize to head and neck
Rhabdomyosarcoma (head/neck)
most common soft tissue sarcoma of childhood, children under 15.
40% in head and neck
tumors arise from skeletal cells and are malignant and aggressive.
Rhabdomyosarcoma (head/neck) 2 types
Embryonal Rhabdomyosarcoma- occur in young child
Alveolar Rhabdomyosarcoma- more common in older children.
Lemierre’s syndrome
rare inflammatory disease.
adolescence after an oropharyngeal infection.
results in thrombophlebitis of the tonsillar veins which propagates into the IJV.
septicemia can occur and result in septic emboli entering the lungs.
*Heerfordt’s disease
acute form of sarcoidosis
includes parotid involvement and facial paralysis.
sono: calcified hypoechoic lesion will be seen in the parotid gland.
