Pediatric emergency medicine trisk 0942 0942

Most children in the ED with a neck mass are not in distress; the leading
diagnoses are reactive adenopathy or acute lymphadenitis from viral or bacterial
infection. A common concern, however, is deciding which neck mass bears the
diagnosis of malignancy and requires biopsy or further evaluation. Table 48.2
lists common nonemergent causes of neck mass.
History
To facilitate differential diagnosis development, it is crucial to determine both the
patient’s age when the mass was first noticed, as well as current symptom
duration. A neck mass presenting at several weeks of life may represent birth
trauma with hemorrhage into the sternocleidomastoid and resulting torticollis.
Conversely, congenital cysts may not come to attention until they have enlarged
with infection or inflammation, often increasing in size with recurrence. Details
of chronicity, size, progression, and evidence of inflammation (e.g., dimples,
sinuses, drainage over time), can help to distinguish between infection and
neoplasm. Although longer duration is concerning for malignancy, the duration
the “node” is present is not reliable in discriminating benign from malignant.
TABLE 48.2
COMMON CAUSES OF NECK MASS
Lymphadenopathy secondary to viral or bacterial infection
Cervical adenitis (bacterial)
Hematoma
Benign tumors—lipoma, keloid
Congenital cyst (squamous epithelial cysts)