Pedia Neck Masses

Question 1

treatment algorithm for pedia neck masses

Answer 1

read

Question 2

what is a branchial cleft cyst

Answer 2

• congenital epithelial cyst
• benign, nontender fluctuant mass
• can become inflamed and form an abscess during an urti

Question 3

types of branchial cleft cysts

Answer 3

1st: near angle of mandible
2d: high in neck, deep to anterior border of scm (most common)
3rd: upper pole of thyroid gland

Question 4

management of branchial cleft cysts

Answer 4

radio: uts, ct, mri

surgical excision

Question 5

what are thyroglossal duct cysts

Answer 5

• form in persistent thyroid descent tract
• elongation of thyroid diverticulum at foramen cecum of tongue -> thyroid gland
• remnant cysts not associated with cutaneous sinus or fistula tract unless surgically drained and inadequately excised

Question 6

manifestation and treatment of thyroglossal duct cyst

Answer 6

• asymptomatic midline neck mass that elevates with swallowing or tongue protrusion
• treatment: sistrunk procedure

Question 7

what are lymphangiomas

Answer 7

• lymphatic malformation from failure of lymph spaces to connect to lymph system
• soft, smooth, nontender, can be compressed and transilluminated

Question 8

complications of lymphangiomas

Answer 8

can cause significant cosmetic deformity

can impair respiration and alimentation

Question 9

types of lymphatic mallformations

Answer 9

• combined venolymphatic malformation (lymphatic and venous)

- macrocystic lymphatic malformation (cystic hygroma)

Question 10

management for lymphangiomas

Answer 10

sclerotherapy if macrocystic (>2 cm)

surgical excision

Question 11

what are hemangiomas

Answer 11

• proliferative endothelial lesion (red or blue soft mass)
• present at birth, involutes at 18-24 mos
• may have bruit over lesions
• ct/mri

Question 12

management of hemangiomas

Answer 12

• observation: involutes after several years
• surgical excision or laser therapy for incomplete involution
• propanolol to reduce angiogenesis and vasoconstriction

Question 13

what are dermoid cysts

Answer 13

• similar to teratomas which are pathologically related
• epithelium lined cavities filled with skin appendages
• from entrapped epithelium during embryogenesis
• common in midline/submental region
• painless

Question 14

management of dermoid cysts

Answer 14

complete surgical excision

Question 15

what are laryngocoeles

Answer 15

• abnormal dilation or hernation of the saccule of the larynx
• hoarseness, cough, dysphagia
• ct scan

Question 16

types of laryngoceles

Answer 16

internal: within thyroid cartilage
external: extends cephalad, protrudes through thyrohyoid membrane

Question 17

management for laryngocoele

Answer 17

surgical excision from external approach

Question 18

what is congenital torticollis

Answer 18

• dense fibrous tissue and absence of normal striated muscle in scm
• firm, painless, discrete, fusiform mass
• appears at 1-8 wks, increased for 2-3 mos, regress for 4-8 mos

Question 19

management of congenital torticollis

Answer 19

conservative mgt with physiotherapy (passive and active motion) preventes teh development of restrictive torticollis

resistant: surgical section of scm

Question 20

more common type of acquired neck mass

Answer 20

viral

Question 21

what is reactive lymphadenopathy

Answer 21

• bilateral
• reactive from benign self-limiting viral urti (adeno, rhino, entero, ebv)
• nodes are small, rubbery, modile, discrete, and minimally tender WITHOUT erythema

Question 22

management of reactive lymphadenopathy

Answer 22

supportive

Question 23

what is suppurative lymphadenopathy

Answer 23

• unilateral
• tender, warm, erythematous, non-discrete, and poorly mobile
• w/ associated symptoms but non toxic
• usually at submandibular and anterior or posterior cervical triangles

Question 24

most common organisms in suppurative lymphadenopathy

Answer 24

s aureus

group a beta hemolytic strep

Question 25

management of suppurative lymphadenopathy

Answer 25

- single course broad spectrum antibiotic, reassessment in 1-2 wks - s aureus/gas: 10 day cefalexin, coamoxiclav, clindamycin

Question 26

what is non-tuberculous mycobacterial lymphadenopathy

Answer 26

- firm and nontender - grows overr several weeks - skin becomes violaceous and thin

Question 27

what are lipomas

Answer 27

- benign encapsulated fatty tumors in the subcutaneous tissue (rare in h&n) - mgt: surgery

Question 28

what are neurofibromas

Answer 28

- circumscribed tumors of schwann cells, nerve fibers, and fibroblasts - small cutaneous nerves or cranial nerves - rarely occur as multiple fibromas (may be nf1) - - mgt: excision

Question 29

what are pleomorphic adenomas

Answer 29

- uncommon - usually salivary gland tumors - mgt: excision

Question 30

most common neck malignancy in pedia

Answer 30

lymphoma

Question 31

types of hodgkin and non hodgkin lymphomas

Answer 31

h: nodular sclerosing, mixed cellularity, lymphocyte predominant, lymphocyte depleted nh: lymphoblastic, large cell, undifferentiated

Question 32

___ lymphoma is more common in the neck

Answer 32

hodgkin

Question 33

mgt for lymphoma

Answer 33

h: chemo or radio nh: chemo

Question 34

clues for diagnosing nasopharyngeal carcinoma

Answer 34

- unilateral otitis media - rhinorrhea - nasal obstruction - 1-2 cn palsies - blacks and asian adolescents - elevated ebv type 2 and 3 titers

Question 35

diagnostics for nasopharyngeal carcinoma

Answer 35

- biopsy - ct/mri for tumor extent - bone scan/abdominal ct for bone or liver metasases

Question 36

mgt for nasopharyngeal carcinoma

Answer 36

combined chemo-radiotherapy

Question 37

what is neuroblastoma

Answer 37

- originate from neuroblasts and neural crest cells - associated with ipsi horner syndrome - sx: lump in abdomen/chest, bone pain, bruising around eyes

Question 38

diagnostics for neuroblastoma

Answer 38

ct/mri of the neck, chest, and abdomen elevated vanillylmendelic acid in 24 hr collection mgt: surgery, radio, chemo