The Child with a Neck Lump

Question 1

What is torticollis?

Answer 1

Any condition where the head is permanently turned to one side

Question 2

What are some causes of torticollis?

Answer 2

• Sternomastoid tumour
  
  • 3 weeks of age - Hard neck lump and inability to turn head to one side, flexed and away-rotated head
  • May cause plagiocephaly (distortion of skull)
• Postural torticollis
  
  • Present at birth due to IU position, disappears in months
• Strabismus (squint)
• Cervical lymphadenitis
• Tumours
• Atlanto-occipital subluxation
• Benign paroxysmal torticollis of infancy - may be a migraine precursor

Question 3

What are some causes of midline neck lumps in a child?

Answer 3

• Thyroglossal cyst (moves with tongue protrusion)
• Ectopic thyroid tissue
• Submental lymph node/abscess (check for mouth infection)
• Dermoid cyst (small, mobile, non-tender, yellowish)
• Goitre
• Cystic hygroma (may be lateral and large, enlarges after URTI)

Question 4

What are some causes of lateral neck swellings in a child?

Answer 4

• Cystic hygroma (enlarged after URTI)
• Lymphadenopathy
• Lymph node tumours
• Brachial cleft cysts (mostly 2nd cleft, on anterior border of SCM +/- salivary sinus)