Pediatric Neck Masses Flashcards by Bina Malapur

When you do a head and neck exam where should you start

begin away from mass and work towards mass

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what might be a possible cause of a mass anterior to the sternocleidomastoid muscle

branchial cleft remnant

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what might be a possible cause of a mass posterior to the sternocleidomastoid muscle

Lyphangioma/cystic hygroma

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What is the most common congenital neck mass?

Thyroglossal duct cyst

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where is thyroglossal duct cyst located

midline

- infrahyoid most common

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when does thyroglassal duct cyst present

during childhood, usually before 10 years of age

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embryology: what does the thyroglassal duct connect

developing thyroid gland and foramen cecum

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what happens 5th week gestsation

thyroglossal loses its lumen and fragments

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What does the mesoderm form?

hyoid bone

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what does hyoid bone divide

duct into suprahyoid and infrahyoids

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when does the attenuated duct atrophy

8th week gestation

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Thyroglassal duct cyst is what type of cyst

epithelial lined cyst

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Thyroglassal duct cyst is a result from what failure

failure of normal obliteration of thyroglassal duct during development

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clinical presentation for thyroglassal duct cyst

painless
if infected- red warm painful lump
- MOVES SUPERIORLY WITH SWALLOWING OR PROTRUSION OF TONGUE
- associated with ectopic thyroid

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what is used to diagnose thyroglossal duct cyst

ultrasound

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what causes Dermoid

outer layers of skin do not properly grow together

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What is in a dermoid

epithelium lined

- tissues, hair follicles, sebaceous, sweat glands ( secrete their stuff which makes dermoid grow)

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on physical exam what is special about dermoid

move independently with skin

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what is the second most common site for Dermoid

neck

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how is dermoid treated

excision

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how is thyroglossal duct cyst treated

surgical resection

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when does branchial cleft cyst present

at birth, may present later

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define branchial cleft cyst

epithelial lined cyst on lateral neck

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what causes branchial cleft cyst

failure of obliteration of one of the branchial clefts

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cyst

no external or internal opening

sinus

internal or external opening

fistula

both internal and external opening

what is the most common first branchial cleft cyst

type 2

what is type 2 first branchial cleft cyst

ectoderm and mesoderm

location of type 2 first branchial cleft cyst

- below angle of mandible | - inferior to external auditory canal or at the bony cartilaginous junction of external auditory canal

what is the most common type of branchial cleft cyst

second branchial cleft cyst

location of second branchial cleft cyst

- inferior to angle of mandible and anterior to the SCM

treatment for second branchial cleft cyst

surgical excision

location of third branchial cleft cyst

anterior to SCM typically lower in neck than 2nd - more common on left side

what is the difference between 3 and 2 branchial cleft cyst

3rd will end in pharynx at thyrohyoid membrane

how does third branchial cleft cyst present

recurrent lower neck infection-polymicrobial

what is cystic hygroma

lymphatic malformation - failure of lymphatic system to connect to venous system - multi-loculated lymphatic lesion

where are cystic hygroma usually found

- left posterior triangle of neck

when can cystic hygroma be diagnosed

prenatal, seen in ultrasound

when does cystic hygroma present

half at birth | most get it by 2 yrs

is cystic hygroma benign or malignant

benign

how does cystic hygroma present

soft, painless, compressible (doughy) mass that may transilluminate

what must the physician worry about with cystic hygroma

airway compression

how is cystic hygroma treated

surgical excision

when does Hemangiomas present

not typically at birth

what is Hemangiomas

bright red macule or papule rash with clear boundaries

what happens when there are 5 or more cutaneous hemangiomas

recommend abdominal MRI ( liver)

What are the 2 stages of hemangiomas

proliferative | involuational

what happens in the proliferative stage of hemangiomas

- begins shortly after birth - grows - may ulcerate

what happens in the involutional stage of hemangiomas

- superficial lesions change from bright red to dull red, then gray - flatten and soften - may complete by 10 yrs

what is the most common location for hemangioma

subglottic region

what is clinical findings for subglottic hemangioma

``` biphasic stridor exacerbated with agitation, crying - initially diagnosed as croup feeding difficulties sleep disturbances ```

Large beard distribution hemangiom plus stridor equals

prompt hospital admission

what is the best imaging for hemangiomas? what type of pattern is seen?

MRI | salt and pepper pattern

what is the treatment for heamingiomas

- small isolated or multiple skin lesions on face should be treated after birth to prevent proliferative phase - close observation

when do you intervene with heamingiomas

- accelerated growth - hemmorrhage - infection - ulceration - funcional porblems - High output congestive heart failure - involves eyelids, nose, lips, auricle

what is that pharmacologic treatment for haemingiomas

propanolol

what are surgical treatment options for haemingiomas

tracheostomy cyrotherapy laster therapy excision

what is torticollis

SCM is tight and short due to muscle injury at birth or in utero - head tilted laterally toward affects muscle, rotated to opposite side

Torticollis presents when

first 6-8 weeks of life

Torticollis is associated with what

hip dysplasia

what is the main treatment for torticollis

exercise to stretch the SCM | - surgery if that does not work

Name 2 acquired pediatric neck masses

lymphadenitis | neoplastic

cervical lymphadenpathy is secondary to what

infection

is cervical lymphadenopathy benign or malignant

benign

when does lymphadenopthy get worrisome

- firm - matted - nontender - greater than 2 cm

how does one treat acute lymphadenopathy ( less than 2 weeks)

broad spectrum antibiotics

how does one treat subacute lymphadenopathy ( 2-6 weeks)

``` CBC PPD CXR EBV Bartonella ```

how does one treat chronic lymphadenopathy ( greater than 6 weeks)

biopsy

what is gold standard for lyphadenopathy

excisional biopsy

what imaging can you get with lymphadenopathy

ultrasound CT with contrast MRI for vascular and lymphatic involvement

what are common viral lymphadenopathy

HIV | non-specific

what are common bacterial lymphadenopathy

acute otitis media, sinusitis, pharyngitis, mycobacterium

atypical mycobacterium lymphadenopathy occurs mostly where

submandibular

characterize mycobacterium lymphadenopathy

- firm, painless mass - has not responded to antibiotics - violet color - may enlarge and become fluctuant - positive PPD

what drugs do you use to treat atypical mycobactrium lymphadenopathy

- macolides- azithro Main choice - rifampin, ethambutal, aminoglycosides, fluoroquinolones - 3 antimicrobials for at least 12 months

what surgery is performed for mycobactrium lymphadenopathy

surgical excision | - not incision and drainage due to risk of chronic sinus tract drainage

how do you diagnose Bartonella lymphadenopthy

serology

what is the treatment for cat scratch lymphadenopathy

doxycycline, erythromycin or azithromycin | - self-limited

name a non-infectious lymphadenopathy

Kawasaki's disease

what are clinical findings for Kawasaki

- fever greater than 5 days - cervical lymphadenopathy - erytherma palms and soles - conjunctivitis - strawberry tongue

what is the most common neoplastic lymphadenopathy

lymphoma

what is the second most common neoplastic lymphadenopathy in children

rhabdomyosarcoma

what is the second most common neoplastic lymphadenopathy in adolescent girls

thyroid carcinoma

what is lymphoma? where is it most common

painless neck mass, | - head and neck presentation

Hodgkins lymphoma commonely presents in who

adolescents

non-hodgkins lymphoma commonly presents in who

2- 12 years age old

what gender is lymphoma more commonly seen in

males

what are 3 increased concern for lymphoma

- greater than 3 cm and firm - involving multiple organs - supraclavicular or posterior triangle location

Hidgkin is associated with what virus

EBV

what is diagnostic tools for lymphoma? treatment?

tissue biopsy bone marrow biopsy PET scan Chemotherapy

What is rhabdomyoscarcoma

sarcoma - malignant cells arise from soft tissue, such as muscles, connective tissue or bone

Rhabdomyosarcoma develops from cells that come from

skeletal muscles

what is the most common type of soft tissue sarcoma

rhabdomyoscaroma

what are 3 maintypes of rhabdomyosarcoma? which one is the most common?

1. embryonal ( most common) 2. alveolar 3. anaplastic

where does embryonal rhabdomyosarcoma usually occur

head neck genital urinary

where does alveolar rhabdomyosarcoma usually occur

arms, legs, chest, abdomen, genital, anal

how does rhabdomyosarcoma present

lump or swelling that keeps getting bigger