NECK MASSES IN CHILDREN

Question 1

What is a thyroglossal cyst and where is it located?

Answer 1

A thyroglossal cyst is located in the anterior triangle, usually midline and below the hyoid, derived from remnants of the thyroglossal duct.

Question 2

What characterizes a branchial cyst on imaging?

Answer 2

Branchial cysts are usually anechoic on ultrasound, indicating a water-like consistency unless infected, and commonly originate from the second branchial cleft.

Question 3

Where are dermoid cysts typically found and what are their imaging characteristics?

Answer 3

Dermoids are typically found in the midline, often suprahyoid, and have heterogeneous appearances on imaging, with variable amounts of calcium and fat.

Question 4

How common are true thyroid lesions in children and what do they usually represent?

Answer 4

True thyroid lesions are rare in children, usually representing either thyroglossal cysts or tumors like lymphoma.

Question 5

Describe the typical characteristics and location of lymphatic malformations.

Answer 5

Lymphatic malformations, like cystic hygroma, are usually located posterior to the sternocleidomastoid, hypoechoic on USS, painless, and fluid-filled, presenting prior to age 2.

Question 6

What are the features of infantile haemangioma in the neck?

Answer 6

Infantile haemangioma may grow rapidly, contain calcified phleboliths on plain x-rays, and often spontaneously regress with increased fat content during involution.

Question 7

What is the typical presentation and location of lymphadenopathy in children?

Answer 7

Lymphadenopathy may occur in either neck triangle, be reactive or neoplastic, and generalised lymphadenopathy is commonly secondary to infection.

Question 8

SUMMARISE

Answer 8

Neck Masses in Children

Thyroglossal cyst
Located in the anterior triangle, usually in the midline and below the hyoid (65% cases)
Derived from remnants of the thyroglossal duct
Thin walled and anechoic on USS (echogenicity suggests infection of cyst)

Branchial cyst
Six branchial arches separated by branchial clefts
Incomplete obliteration of the branchial apparatus may result in cysts, sinuses or fistulae
75% of branchial cysts originate from the second branchial cleft
Usually located anterior to the sternocleidomastoid near the angle of the mandible
Unless infected the fluid of the cyst has a similar consistency to water and is anechoic on USS

Dermoids
Derived from pleuripotent stem cells and are located in the midline
Most commonly in a suprahyoid location
They have heterogeneous appearances on imaging and contain variable amounts of calcium and fat

Thyroid gland
True thyroid lesions are rare in children and usually represent thyroglossal cysts or tumours like lymphoma

Lymphatic malformations
Usually located posterior to the sternocleidomastoid
Cystic hygroma result from occlusion of lymphatic channels
The painless, fluid filled, lesions usually present prior to the age of 2
They are often closely linked to surrounding structures and surgical removal is difficult
They are typically hypoechoic on USS

Infantile haemangioma
May present in either triangle of the neck
Grow rapidly initially and then will often spontaneously regress
Plain x-rays will show a mass lesion, usually containing calcified phleboliths
As involution occurs the fat content of the lesions increases

Lymphadenopathy
Located in either triangle of the neck
May be reactive or neoplastic
Generalised lymphadenopathy usually secondary to infection in children (very common)