Pediatric emergency medicine trisk 0948 0948

FIGURE 48.2 Differential diagnosis of neck mass by location. Area 1. Parotid: cystic
hygroma, hemangioma, lymphadenitis, parotitis, Sjögren and Caffey–Silverman syndrome,
lymphoma. Area 2. Postauricular: lymphadenitis, branchial cleft cyst (1st), squamous epithelial
cyst. Area 3. Submental: lymphadenitis, cystic hygroma, sialadenitis, tumor, cystic fibrosis.
Area 4. Submandibular: lymphadenitis, cystic hygroma, sialadenitis, tumor, cystic fibrosis.
Area 5. Jugulodigastric: lymphadenitis, squamous epithelial cyst, branchial cleft cyst (1st),
parotid tumor, normal—transverse process C2, styloid process. Area 6. Midline neck:
lymphadenitis, thyroglossal duct cyst, dermoid, laryngocele, normal—hyoid, thyroid. Area 7.
Sternocleidomastoid (anterior): lymphadenitis, branchial cleft cyst (2nd, 3rd), pilomatrixoma,
rare tumors. Area 8. Spinal accessory: lymphadenitis, lymphoma, metastasis (from
nasopharynx). Area 9. Paratracheal: thyroid, parathyroid, esophageal diverticulum. Area 10.
Supraclavicular: cystic hygroma, lipoma, lymphoma, metastasis, normal—fat pad,
pneumatocele of upper lobe. Area 11. Suprasternal: thyroid, lipoma, dermoid, thymus,
mediastinal mass. (From May M. Neck masses in children: diagnosis and treatment. Pediatr
Ann 1976;5(8):517–535. Reprinted by permission.)

Thoracoabdominal examination should pay special attention to auscultation
and consideration for other signs of systemic illness. Extrathoracic compression
of the upper airway may manifest only as faint inspiratory stridor. A goiter may
be coupled with signs of thyroid hormone excess (e.g., tachycardia, bounding