Neck Lumps

Question 1

What are the common causes of neck lumps in children?

Answer 1

• Thyroglossal cysts - failure of thyroglossal duct to involute
  
  • Most common midline congenital mass
• Branchial cleft abnormality - failure of pharyngeal clefts to involute
  
  • Most common lateral congenital mass
• Lymphadenitis
  
  • Most common neck lump in children

Question 2

What are the red flag signs and symptoms of neck lumps in children?

Answer 2

• Sepsis/unwell
• Stridor
• Poor feeding
• Change in voice
• Rapid progression

Question 3

What are the signs and symptoms of thyroglossal cysts?

Answer 3

Midline mass that moves with swallowing

Question 4

What are the signs and symptoms of brachial cleft abnormality?

Answer 4

• Cyst, sinus or fistula
• Signs of infection

Question 5

What are the signs and symptoms of lymphadenitis?

Answer 5

• Transiently enlarged, tender lymph nodes
  
  • Often be multiple small tender bump

Question 6

What are the appropriate investigations for neck lumps?

Answer 6

• Clinical examination
• Systemic symptoms = FBC and blood film
• Thyroglossal cyst = Thyroid USS
• Atypical lymphadenopathy → TB PPD test; bartonella henselae, EBV, CMV, HIV, toxoplasmosis serology

Question 7

What is the management of lymphadenitis?

Answer 7

• Self-limiting (6 weeks)
• ABx if secondary bacterial infection occurs
  
  • Also requires follow-up investigations

Question 8

What is the management of thyroglossal cysts?

Answer 8

• Asymptomatic = conservative management
• Symptomatic = surgical removal