Peds Neck Masses (6)- Melissa Flashcards Preview

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Flashcards in Peds Neck Masses (6)- Melissa Deck (48):
1

5 congenital pediatric neck lesions (types)

1. thyroglossal duct cyst
2. branchial cleft cyst
3. dermoid
4. cystic hygroma
5. hemangioma

2

3 acquired pediatric neck lesions (types)

1. lymphadenitis
2. neoplasm
3. thyroid

3

Where does one begin to inspect when doing PE for meds neck mass?
What should you look for on the full body exam? (4)
What is the best way to examine pediatric liver?

Inspect scalp and start AWAY from lesion--> towards lesion
Look for primary site if infection, skin lesions, adenopathy, spleen/ liver anomalies

*Scratch test is good for peds liver

4

What is the FIRST CLUE when diagnosing peds neck lesions?

LOCATION:
Anterior triangle
Midline
Posterior triangle
Supraclavicular

5

Important midline lesions: (3)

- thyroglossal duct cyst
- dermoid
- teratoma

6

Important anterior triangle lestions:

branchial cleft cysts

7

Important posterior triangle lestions:

lymphangioma/ cystic hygroma

8

Important periauricular lesions: (2)

parotid or submandibular gland lesions

9

Congenital anterior midline lesion that moves SUPERIORLY with swallowing:
Which tests should you perform (4)
What is the likely diagnosis based on description?

Free T4, thyroid scan CT, U/S, Aspirate
*Thyroglossal duct cyst

(May be associated with ectopic thyroid)

10

Anterior triangle lesion +/- fistula:
Diagnostic test?
Most likely diagnosis?

CT/ MRI
Branchial cleft cyst

11

Soft, spongy, posterior triangle lesion:
Best diagnostic test
Most likely dx?

#1: MRI
Cystic Hygroma

12

Lesion in the belly of the SCM:
Most likely dx?
What will this typically feel like?

Congenital torticollis
*May feel like a knot inside the muscle

13

Soft, spongy, purple/red lesion ANYWHERE on kiddo:
Diagnostic tests? (2)
Most likely dx?

US, CT (rarely necessary...)
Hemangioma

14

Lateral submandibular lesion of the salivary gland:
What is the most likely dx if inflammation is present/ not present?

Inflammation: acute infection
No inflammation: calcus mucocele/ tumor bulimia

15

Acquired anterior midline lesion that moves with swallowing:
Most likely dx?
What are the terms that define the lesions etiology?

Most likely a goiter
- HARD/ RAPID GROWTH--> thyroid scan/ biopsy--> TUMOR

-Slow growing and soft --> free T4/ antithyroid Ab test --> thyroiditis or graves

16

Acquired cervial mass with drainage, Horner's, and raccoon eyes:
Diagnostic testing and most likely dx?

CT; Rhabdo or neuroblastoma

17

#1 congenital neck mass?
When do they typically present?
How do we treat them>

Thyroglossal duct cyst
- typically presents before 10 yoa; may be asx if never infected
- Tx with surgical resection

18

Briefly describe the normal function of the thyroglossal duct; when should it typically attenuate and atrophy?

How do thyroglossal duct cysts happen?
How are they classified?

Thyroglossal duct connects foramen cecum to developing thyroid gland; should attenuate and atrophy by 8th week gestation.
***Failure to obliterate thyroglossal duct = TGD cyst
***Hyoid bone divides thyroglossal duct into supra/infra hyoid regions--> infra/ supra hyoid thyroglossal duct cysts!

19

Describe the histo of a TGD cyst.
Are they painful?
Which type is most common?

- Epithelial lined cyst
- NOT PAINFUL; may be swollen/ red/ warm if infected
- #1 = infrahyoid--> hyoid--> suprahyoid

20

What causes a dermoid cyst?
What lines these masses and what to these masses contain?
What causes these masses to enlarge?
What do they feel like and where are thy commonly located?
How do we treat them?

- Outer layers of skin fail to properly grow together
- Lined with epi; contain hair/gland/dental tissue etc.
- Contents (glands) produce normal secretions --> enlarge dermoid
- Will feel doughy, move with skin on exam
- Commonly located on the neck
- Tx with surgery


(THIS IS WHAT THEY THINK MY BUTT THING IS AND THATS WHY SPIRO WORKS! IT DECREASES GLANDULAR SECRETIONS.)

21

What causes a brachial cleft cyst?
When do these typically present?
What are the three types?

- Failure of 1st, 2nd, or 3rd branchial cleft to obliterate
- Typically present at birth; 20% of all peds neck masses

1. cyst- no external opening
2. sinus- internal or external opening
3. fistula- both internal + external opening

22

How do we differentiate type 1 vs type 2 first branchial cleft cyst?
Which is most common?

Type 1:
- ectoderm only
- passes through parotid gland hear CNVII
- mass with fistula in skin
(1= more superficial)

Type 2: MORE COMMON
- @ angle of mandible
- ectoderm + mesoderm
- passes through parotid medial or lateral to CN VII

23

Which branchial cleft is most likely to cause a cyst?
Where are these located?
How do we treat?

SECOND BRANCHIAL CLEFT CYST = #1
- inferior to angle of mandible; anterior to scm
- treat with surgical excision

24

Where is a third branchial cleft cyst located?
More common on right or left side?
How do they present?

- anterior to scm; LOWER in neck than second cleft cyst
- more common on LEFT
- may see polymicrobial recurrent infection

25

Describe the etiology of a cystic hygroma?
What kind of lesion is this?
When are these commonly diagnosed?
What do they feel like/ present on PE? (2)

Failure of lymphatic system to connect to venous system--> Multilobulated lymphatic lesion

- Commonly diagnosed prenatally
- Soft, painless, doughy mass
- May TRANSILLUMINATE

26

When should a child with hemangioma have MRI of the liver?

MORE than 5 cutaneous hemangiomas

27

Best imaging studies for dermoid cyst?

US or CT if necessary

28

Describe the progression of a hemangioma from birth to regression:

reaches 85% of full size by 5 mos--> peaks at 12-18 mos--> regresses with minimal scarring

29

List two hemangiomas that might mandate surgical intervention.

1. Subglottic hemangioma (airway constriction )
2. Eyelid hemangioma (visual impairment)

30

Which kids are at high risk for subglottic hemangioma?
What do we hear on exam?
What is one common misdiagnosis?
How do we treat these kids?

HIGH RISK = Segmental beard distribution cutaneous hemangiomas
- Kids have BIPHASIC stridor, feeding and sleeping issues
- Commonly misdiagnosed as croup
- Tx: fiborptic laryngoscopy/ operative bronch

31

Study of choicee for hemangiomas if warranted?
What do you see?

MRI with gadolinium
dilated feeding/ draining vessels = salt and pepper pattern

32

Pharmacological treatment for hemangioma?

Propranolol!

33

When/ how does torticollis present?
What is the most common cause?
What is one high yield association?
How is it treated?

Presents in first 6-8 weeks of life with shortened scm; head deviates towards lesion

Caused by positioning in utero or trauma at birth
May be associated with hip dysplasia
#1 Tx = STRETCH THE KIDDO!

34

Three things to never forget when taking history for lymphadenopathy complaint?

- travelz
- kittiez
- drugz

35

Worry about these nodes when they are enlarged (6):

- occipital
- auricular
- supraclavicular
- mediastinal
- epitrochleal
- posterior cervical

(aka NOT cervical, axillary, inguinal!!)

36

Lymphadenopathy is likely LESS DANGEROUS (secondary to infection) when... (5):

When is it dangerous?

1. localized
2. UNDER 1-2cm
3. cervical, axillary, inguinal nodes
4. red/ tender/ warm
5. fluctuant

*Opposite of all of the above + systemic sx. = cause for concern*

37

What constitutes acute lymphadenopathy?
How is it treated?

UNDER 2 weeks-- treat with broad spectrum ABX

38

What constitutes subacute lymphadenopathy?
How's it treated?
When do we biopsy?

2-6 weeks
Workup for infection
Biopsy if 3+cm, no response to ABX or if there are other risk factors for malignancy

39

What constitutes chronic lymphadenopathy?
How's it treated?

OVER 6 weeks
Biopsy 100%

40

How do we do LN biopsy on kiddos?

FNA is not worth the trouble of sedation because is low yield; get a whole chunk if you're gonna go through the trouble of knocking kiddo out

41

Which infectious lymphadenopathy is most common?

#1: Viral

42

How does mycobacterium lymphadenopathy present (2)?
How do we treat it?
Do we perform surgery?

- Firm painless mass; no response to ABX
- "Violaceous hue"
- Tx with macrolides
- Surgical excision ONLY; no incision and drainage--may cause possible chronic sinus tract drainage

43

Bartonella Hanselae causes what disease in kiddo lymph nodes? Where should you look on PE to make dx?
Describe the course + treatment .

Cat scratch disease: nodule at site of inoculation--look at the kiddo's fingers *also note that arm pits are a common site of enlarged nodes per first aid.*
- Self limited course 6-12 weeks
- Tx with doxy or macrolide
- NO SURGERY NEEDED

44

KAWASAKI DISEASE:
What do you see?
How do you treat?
How do you differentiate from virus?

Why is this a big deal?

CRASH + BURN
(conjunctivitis, rash, cervical lymphadenopathy, strawberry tongue, hand and foot edema/ erythema, fever 5+days)
Tx: IVIG + ASN
*Kids will have sterile pyuria and longer fever than virus
*Big deal because these kids have a risk of coronary aneurysm/ MI

45

Order the childhood neoplastic lymphadenopathies from most common to least common:

#1: lymphoma
2. rhabdomyosarcoma
3. thyroid ca.

46

How does pediatric lymphoma present in head/ neck?
Hodgkins vs. nonhodgkins: which age group gets which?
M or F more common?

Presents as painless neck mass
Hodgkin = adolescents (remember assn. w/ EBV)
Non-hodgkin = 2-12 yoa
More common in MALES

47

What is the most common type of soft tissue sarcoma in kids?
What are the three subtypes?
What is the most common subtype?

Rhabdomyosarcoma
#1. Embryonal *TADPOLES*
2. Alveolar
3. Anaplastic

48

Embryonal Rhabdomyosarcoma: Where do these typically appear? (2) Alveolar? Anaplastic?

- BOTH embryonal and alveolar= GU
- Embryonal = neck
- Alveolar = trunk and limbs

*Note that you do not typically see anaplastic in kids*