Pediatric emergency medicine trisk 0941 0941

(i.e., Kawasaki disease) often have cervical lymphadenopathy and, on rare
occasions, have active life-threatening vasculitis of the coronary vessels.
Although neck tumors generally grow outward, in children, they may become
large enough to encroach on vital structures. Lymphoma, an uncommon but
important cause of neck mass, is usually associated with painless enlargement
(often of supraclavicular nodes) that occurs over several weeks in the older
school-aged children. Anterior mediastinal node involvement creates airway
collapse in the supine position secondary to tracheal compression. This may
manifest as orthopnea. Cystic hygromas and hemangiomas occasionally enlarge
sufficiently enough to interfere with feeding or to obstruct the airway. Other
neoplasms, such as rhabdomyosarcoma, leukemia, neuroblastoma, and
histiocytosis X, are life threatening because of local invasion and metabolic and
hematologic effects. Table 48.1 lists disorders that constitute true emergencies
because of local pressure on vital structures or because of systemic toxicity.
TABLE 48.1
LIFE-THREATENING CAUSES OF NECK MASS
Hematoma secondary to trauma
Cervical spine injury
Vascular compromise or acute bleeding
Late arteriovenous fistula
Subcutaneous emphysema with associated airway or pulmonary injury
Local hypersensitivity reaction (sting/bite) with airway edema
Airway compromise with epiglottitis, peritonsillar abscess, or infection of floor
of mouth or retropharyngeal space (with adenopathy)
Bacteremia/sepsis associated with local infection of a cyst (cystic hygroma,
thyroglossal, or branchial cleft cyst)
Non-Hodgkin lymphoma with mediastinal mass and airway compromise
Thyroid storm
Mucocutaneous lymph node syndrome with coronary vasculitis (Kawasaki
disease)
Tumor—leukemia, lymphoma, rhabdomyosarcoma, histiocytosis X

Lemierre syndrome

Child With Neck Mass and No Distress