Neck lumps

Question 1

Features

Answer 1

80% of neck lumps are benign.

Benign lumps usu. occur in anterior triangle

while malignant lumps are commonly in posterior triangle.

Question 2

Sternomastoid tumour/fibrosis

Answer 2

Features in infants:

• hard painless lump (2–3 cm) in muscle
• tight and shortened sternomastoid
• apparent at 20–30 days of age
• torticollis—head away from but tilted towards the tumour

Most resolve spont. within 1 yr.

Refer to physiotherapy early.

Gently massage lump and stretch neck away from the tumour.

Rarely surgery—best <12 mths

Question 3

Thyroglossal cyst

Answer 3

This most common midline neck swelling

Moves with swallowing and tongue protrusion.

Prone to infection inc. abscess.

Best to excise early

Question 4

Lymphatic malformation/cystic hygroma

Answer 4

Presents as a soft cystic tumour of :

• neck
• face or
• oral cavity.

Poor localised cluster of vesicles ± visible red dots.

Surgery best early.

If in mouth/pharynx can endanger airway.

Question 5

Cervical lymphadenopathy

Answer 5

Most enlarged nodes are either ‘normal’ or local infections (mainly viral)

• esp. if <2 cm diameter and not hard or fixed.

Inflammatory nodes are of concern if:

• supraclavicular node enlargement and fever.

Suspicious nodes are (refer for investigation):

• >2.5 cm
• firmer consistency
• and less mobile.

Question 6

MAIS (Mycobactyerium AIS) lymphadenitis

Answer 6

• Painless swelling (cold abscess)
• over 4–6 wks in 2–3 yrs child
• unresponsive to antimicrobials

treat by surgical excision.