Meier JD, Grimmer JF. Evaluation and management of neck masses in children. Am
Fam Physician. 2014 Mar 1;89(5):353-8.
Neck masses in children usually fall into one of three categories: developmental, inflammatory/reactive, or neoplastic. Common congenital developmental masses in the neck include thyroglossal duct cysts, branchial cleft cysts, dermoid cysts, vascular malformations, and hemangiomas. Inflammatory neck masses can be the result of reactive lymphadenopathy, infectious lymphadenitis (viral, staphylococcal, and mycobacterial infections; cat-scratch disease), or Kawasaki disease. Common benign neoplastic lesions include pilomatrixomas, lipomas, fibromas, neurofibromas, and salivary gland tumors. Although rare in children, malignant lesions occurring in the neck include lymphoma, rhabdomyosarcoma, thyroid carcinoma, and metastatic nasopharyngeal carcinoma. Workup for a neck mass may include a complete blood count; purified protein derivative test for tuberculosis; and measurement of titers for Epstein-Barr virus, cat-scratch disease, cytomegalovirus, human immunodeficiency virus, and toxoplasmosis if the history raises suspicion for any of these conditions. Ultrasonography is the preferred imaging study for a developmental or palpable mass. Computed tomography with intravenous contrast media is recommended for evaluating a malignancy or a suspected retropharyngeal or deep neck abscess. Congenital neck masses are excised to prevent potential growth and secondary infection of the lesion. Antibiotic therapy for suspected bacterial lymphadenitis should target Staphylococcus aureus and group A streptococcus. Lack of response to initial antibiotics should prompt consideration of intravenous antibiotic therapy, referral for possible incision and drainage, or further workup. If malignancy is suspected (accompanying type B symptoms; hard, firm, or rubbery consistency; fixed mass; supraclavicular mass; lymph node larger than 2 cm in diameter; persistent enlargement for more than two weeks; no decrease in size after four to six weeks; absence of inflammation; ulceration; failure to respond to antibiotic therapy; or a thyroid mass), the patient should be referred to a head and neck surgeon for urgent evaluation and possible biopsy.
Sahai S. Lymphadenopathy. Pediatr Rev. 2013 May;34(5):216-27. doi:
After completing this article, readers should be able to:
- Define lymphadenopathy
- Know the differential diagnosis for localized and generalized lymphadenopathy
- Know the etiology and evaluation of acute and chronic cervical lymphadenopathy
- Know the age-dependent microbiology of acute cervical lymphadenitis
- Recognize the “red flags” associated with noninfectious causes of lymphadenopathy
Full-text for Children’s users.
Book Chapter: Cervical lymphadenitis. From Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 6th ed. (2009). pgs. 185-197.
“The clinical manifestations of cervical lymphadenitis vary considerably but are consistent with the diverse etiologies associated with cervical node enlargement in infants and children. To categorize the mode of presentation as either acute or subacute and chronic is useful because, although the boundaries are ill-defined and much overlap exists, common etiologies tend to fall consistently within one or another category. Cervical lymphadenitis of acute onset may be categorized further as either bilateral or unilateral. In most situations, acute, bilateral cervical adenitis is either part of a generalized reticuloendothelial response to a systemic infection or a localized reaction to acute pharyngitis. The presence or absence of associated features (e.g., pharyngitis, enanthems or exanthems, generalized adenopathy, hepatosplenomegaly) aids in making the differentiation.”
Full-text for Emory users.
“Cervical lymphadenopathy is a common problem in children. The condition most commonly represents a transient response to a benign local or generalized infection. Acute bilateral cervical lymphadenitis is usually caused by a viral upper respiratory tract infection or streptococcal pharyngitis. Acute unilateral cervical lymphadenitis is caused by streptococcal or staphylococcal infection in 40% to 80% of cases. Common causes of subacute or chronic lymphadenitis include cat-scratch disease and mycobacterial infection. Generalized lymphadenopathy is often caused by a viral infection, and less frequently by malignancies, collagen vascular diseases, and medications. Laboratory tests are not necessary in most children with cervical lymphadenopathy. Most cases of cervical lymphadenitis are self-limited and require no treatment. The treatment of acute bacterial cervical lymphadenitis without a known primary source should provide adequate coverage for both Staphylococcus aureus and Streptococcus pyogenes.”
Full-text access for Emory users.
“Lymphadenopathy of the head and neck region is a common finding in children and a very common reason to image the craniocervical region. Enlarged lymph nodes are commonly palpated by the pediatrician in the office and commonly imaged by the pediatric radiologist. The difficult task of the clinician is to determine whether the adenopathy is acute (<3 weeks) or chronic (>6 weeks) and when imaging is indicated. In children, radiation is always a consideration when choosing an imaging modality; thus, US is usually the first imaging study at our institution, and CT the second option, usually reserved for the very ill child or for when there is a high index of suspicion for malignancy. We present the normal anatomy of head and neck lymph nodes and the US, CT, and MRI appearances in normal and pathologic states to help clinicians generate a reasonable differential diagnosis and prevent unnecessary procedures.”
Nield LS, Kamat D. Lymphadenopathy in children: when and how to evaluate. Clin
Pediatr (Phila). 2004 Jan-Feb;43(1):25-33.
“The lymph nodes enlarge due to proliferation of the lymphocytes in the lymph nodes in response to infection or due to lymphoproliferative disorder, and also due to infiltration of lymph nodes by inflammatory or malignant cells. Infection is the most common trigger for lymph node enlargement in children. To simplify the evaluation and management of the child with lymphadenopathy, one can approach this issue by dividing it into the following categories: acute infective lymphadenitis, acute lymphadenopathy, and chronic lymphadenopathy. Lymphadenopathy can be defined as acute if it lasts less than 3 weeks or chronic if it lasts longer than 6 weeks.”
More PubMed results on cervical lymphadenitis.
Created 06/07/13; updated 04/15/14.