Pediatric Neck Masses

Question 1

What are the three most common causes of midline neck lesions in pediatric patients?

Answer 1

Thyroglossal duct cyst

Dermoid cyst

Lymph node

Question 2

What is the typical form of congenital neck lesions?

Answer 2

Often cysts rather than solid masses, but can be solid

Question 3

What is the difference in presentation between congenital, infectious, and neoplastic neck lesions in pediatric patients?

Answer 3

Congential: often cysts

Infections: cysts or solid, with signs of infection

Neoplastic: often masses

Question 4

What is the most common initial imaging study for pediatric neck masses?

Answer 4

Ultrasounds

Question 5

Which type of imaging is best for bone detail? Soft tissue detail?

Answer 5

CT - bone detail

MRI - soft tissue detail

Question 6

What is the embryological basis of thyroglossal duct cysts?

Answer 6

4th week gestation - epithelium of part of future tongue evaginates to form the thyroglossal duct

Normally it involutes at 8-10 weeks

Cysts form when it doesn’t involute and remains present after birth

Question 7

Where do thyroglossal duct cysts normally form?

Answer 7

Near the hyoid bone and cervicomental angle

Question 8

What is the recommended definitive treatment for thyroglossal duct cysts?

Answer 8

Excision of cyst along with portion of hyoid bone (Sistrunk procedure)

Question 9

What are cervical dermoid cysts?

Answer 9

Cysts formed from trapped epithelial elements (ectoderm and endoderm) along embryologic lines of fusion

Question 10

What is the recommended definitive treatment for a cervical dermoid cyst?

Answer 10

Excision of the cyst

Question 11

What is the most likely diagnosis for a child with bilateral neck pits that have intermittent mucous drainage?

Answer 11

Branchial cleft anomalies

Question 12

Bilateral branch anomalies should prompt closer inspection of what organ systems?

Answer 12

Ears and kidneys

branchial-oto-renal syndrome

Question 13

What is a cyst vs. sinus vs. fistula?

Answer 13

Cyst = retained epidermal lined space without communcation to mucosa or skin

Sinus = epidermal lined duct with external or internal communication

Fistula = epidermal lined tract communicating pharynx to skin

Question 14

What is the most common type of branchial cleft anomaly?

Answer 14

Second branchial anomaly

Question 15

What structures are associated with the second branchial cleft?

Answer 15

Arch: muscles innervated by facial nerve + bony structures (hyoid, stylohyoid ligament, styloid process, stapes)

Puch: palatine tonsils

Question 16

What is the classical fistula clinical course of a second branchial cleft anomaly?

Answer 16

Pit anterior to the sternocleidomastoid that pierces the platysma and investing layer of deep cervical fascia

Deeper through carotid artery bifurcation

Opens to tonsillar fossa

Question 17

What are the characteristics of lymphatic malformations?

Answer 17

• diagnosed before age 2
• ectatic, thin-walled, irregularly shaped

Question 18

What is the classical presentation of atypical mycobacterial infection?

Answer 18

Typical in children ages 1-5, endemic to soil in midwestern and southwestern US

Mass along cervical lymph node regions with intact skin. Skin develops an erythematous or violaceous color.

Question 19

What is the treatment of atypical mycobacterial infection?

Answer 19

> 6 months course of antibiotics

Surgery with incision and drainage/curettage/resection

Question 20

What glands can be involved in salivary gland lesions?

Answer 20

Parotid (most common), submandibular, sublingual

Question 21

What is the most common pediatric thyroid malignancy?

Answer 21

Papillary thyroid carcinoma