PEDIATRICS Section 3: Head and Neck

Question 1

Embryology wise, the thyroid starts where?

Answer 1

at the back of the tongue and descends downward to a location that would be considered normal.

Question 2

What represents the persistence of the inferior portion of the thyroglossal duct?

Answer 2

“Pyramidal lobe”

Question 3

What happens when normal descent of the tongue gets fucked up?

Answer 3

The thyroid either:

Stays at the back of the tongue (lingual thyroid)

or

Ends up halfway down the neck or even in the chest (Ectopic thyroid)

Question 4

How do you diagnose ectopic tissue?

Answer 4

Nukes (I-23 or Tc-MIBI) –> superior

next is CT

Question 5

What is the most common locationof ectopic thyroid tissue?

Answer 5

Lingular thyroid (back of the tongue)

Question 6

What is the embryological thyroid interstate highway to the neck?

Failure to involute fully results in?

Answer 6

Thyroglossal duct

Cyst (Thyroglossal duct) - hence the name

Question 7

Classic location of Thyroglossal duct cyst

Answer 7

1. Base of the tongue
2. Midline anterior to the hyoid

Question 8

Diagnosis?

Answer 8

Thyroglossal Duct Cyst

Question 9

“MIDLINE” cyst in the neck of a Kid

Answer 9

Thyroglossal Duct Cyst

Question 10

Next step after you looke for Midline cyst in the neck of a kid?

Answer 10

Confirm Normal thyroid location and/or look for ectopic tissue (USD +/- Tc-MIBI or I-123)

Question 11

If you see a nodule within a suspected cyst in the midline cyst in the neck of a kid - consider?

Answer 11

CANCER (usually papillary

Question 12

Sign of infection in Thyroglossal duct cyst

Answer 12

Rim enhancement + Fatty stranding

Question 13

Management for Thyroglossal Duct Cyst

Answer 13

Sistrunk Procedure - Remove cyst, tract + hyoid = decreases recurrence

Question 14

Where do dermoid cyst usually occur? but when they happen in the neck, what will be the classic look?

Answer 14

It is true that dermoids almost always occur below the clavicles, but when they do happen in the neck they have a pretty classic look; midline sublingual / submandibular space with a “sac of marbles” appearance.

Question 15

Diagnosis? Describe

Answer 15

Dermoid cys- marbles of lobules of fat within the fluid

Question 16

What is the most common branchial cleft cyst?

Answer 16

2nd Branchial clef cyst (95%)

Question 17

Classic location of branchial cleft cyst.

Answer 17

Angle of the mandible

Question 18

Diagnosis? what is the sign?

Answer 18

Branchial cleft cyst

Extension of the cyst between ICA and ECA just above the carotid bifurcation - “Notch Sign”

Question 19

Where is the 2nd branchial cleft cyst specifically located?

Answer 19

Posterior and lateral to the submandibular gland or lateral to the carotid space, or anterior to the sternocleidomastoid

REMEMBER - Lateral to everything

Question 20

2nd branchial cleft cyst buzzword

Answer 20

“LATERAL”

Question 21

BCC (branchial cleft cyst) mimics

Answer 21

Necrotic level 2 lymph node
Thyroid CA (History of radiation exposure)
NPC (History of HPV) - Early adulthood

Question 22

If you have a new Branchial cleft cyst in an 18 year old, what do you consider?

Answer 22

A necrotic node.

Question 23

I say LATERAL cyst in the neck you say?

Answer 23

Branchial Cleft Cyst (BCC)

Question 24

I say MIDLIN cyst in the neck, you say?

Answer 24

Thyroglossal duct cyst (TGDC)

Question 25

What are the two jugular vein issues that occur in kids that are worth mentioning?

Answer 25

Septic Thrombophlebitis and Phlebectasia

Question 26

a.k.a clotted jugular vein

Answer 26

Septic Thrombophlebitis

Question 27

In what setting do you usually see Septic Thrombophlebitis?

Answer 27

recent pharyngeal infection (or recent ENT surgery)

Question 28

is a rare complication of bacterial pharyngitis/tonsillitis and involves an extension of the infection into the lateral pharyngeal spaces of the neck with subsequent septic thrombophlebitis of the internal jugular vein(s)

Answer 28

Lemierre syndrome (LS)

Question 29

After identifying Septic Thrombophlebitis, what should you do next?

Answer 29

Look for septic emboli in the lungs

Question 30

What bacteria causes septic emboli?

Answer 30

Fusobacterium necrophorum

Question 31

Diagnosis?

Answer 31

Lemierre Syndrome

Question 32

Idiopathic dilated Jugular vein

Answer 32

Phlebectasia

Question 33

A six-year-old child with no particular past medical history presented with a two-year history of progressively enlarging mass on the right side of the neck. Diagnosis?

Answer 33

Phlebectasia