Pediatric Neck Masses

What is a neck mass?

A neck mass is a swelling of the neck that can be felt or seen. Neck masses may be present at birth (congenital) or develop later in life (acquired), although some congenital neck masses may not become apparent until a child is older. Neck masses in kids are usually non-cancerous.

What will my child’s doctor want to know?

Your child’s doctor will ask many questions to aid in diagnosis and treatment. When did you first notice the mass, and how long has it been there? Is there more than one mass? Has the mass changed in appearance? Is it leaking fluid? Does your child have pain, swallowing concerns, or breathing issues? Has your child had any recent travel, animal exposures, or illnesses? Has anyone else in the family had neck masses? Your child’s physician will use both this information and a thorough physical examination to narrow down the potential causes of the neck mass and make a referral to an otolaryngologist (ENT) if needed.

Causes of neck masses

The specific location of the mass in the neck gives clues to the type of mass your child may have.

Middle of the Neck (Midline)

Thyroglossal duct cyst: This is the most common pediatric neck mass, and it is benign (non-cancerous). During embryonic development, the thyroid gland forms high up in the neck and then moves down to its typical position by birth. Sometimes a persistent “trail” of embryonic thyroid tissue is left behind, and this extra thyroid tissue is what causes the thyroglossal duct cyst. This cyst is most commonly seen in children 2 to 10 years old.

Dermoid cyst: This is a benign cyst composed of skin cells and skin tissue such as hair follicles and sweat glands that are trapped below the skin. These cysts can be seen at birth or later in life.

Thyroid nodule: This is a firm lump or swelling in the thyroid gland. The majority of thyroid nodules in children are benign.

Sides of the Neck (Lateral)

Branchial cleft anomaly: This benign lesion occurs when the neck tissues do not form normally in the womb. It appears as a mass, draining pit, or fullness on the side of the neck that can be near the surface of the skin or deep in the neck. This lesion is present at birth, but sometimes it is not detected until later in life.

Vascular malformation: This benign growth is caused by abnormal development of blood vessels (veins, arteries or capillaries), lymph nodes, or a mixture of both. While many of these malformations are noticed around the time of birth, some may mature and enlarge over the first year of life. One example of a common vascular malformation is an infantile hemangioma.

Testing

Your child’s doctor may request bloodwork and imaging such as an X-ray, CT Scan, MRI, or ultrasound. These tests help your surgeon determine which type of mass your child has, what other important neck structures it is near, and how to best treat it.

Treatment

Your doctor will discuss with you treatment options including possible surgery. Excision of the mass may require special surgical approaches or a multidisciplinary team.

For more information please see the below publications:

Congenital Neck Masses. Quintanilla-Dieck L, Penn EB Jr. Clin Perinatol. 2018 Dec;45(4):769-785. doi: 10.1016/j.clp.2018.07.012. Epub 2018 Sep 18. PMID: 30396417.

Pediatric Inflammatory Adenopathy. Penn E, Goudy S. Otolaryngol Clin North Am. 2015 Feb;48(1):137-51.