Flashcards in Peds Neck Masses (6)- Melissa Deck (48)
5 congenital pediatric neck lesions (types)
1. thyroglossal duct cyst
2. branchial cleft cyst
4. cystic hygroma
3 acquired pediatric neck lesions (types)
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
What is the FIRST CLUE when diagnosing peds neck lesions?
Important midline lesions: (3)
- thyroglossal duct cyst
Important anterior triangle lestions:
branchial cleft cysts
Important posterior triangle lestions:
lymphangioma/ cystic hygroma
Important periauricular lesions: (2)
parotid or submandibular gland lesions
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)
Anterior triangle lesion +/- fistula:
Most likely diagnosis?
Branchial cleft cyst
Soft, spongy, posterior triangle lesion:
Best diagnostic test
Most likely dx?
Lesion in the belly of the SCM:
Most likely dx?
What will this typically feel like?
*May feel like a knot inside the muscle
Soft, spongy, purple/red lesion ANYWHERE on kiddo:
Diagnostic tests? (2)
Most likely dx?
US, CT (rarely necessary...)
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
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
Acquired cervial mass with drainage, Horner's, and raccoon eyes:
Diagnostic testing and most likely dx?
CT; Rhabdo or neuroblastoma
#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
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!
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
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.)
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
How do we differentiate type 1 vs type 2 first branchial cleft cyst?
Which is most common?
- 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
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
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
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
When should a child with hemangioma have MRI of the liver?
MORE than 5 cutaneous hemangiomas
Best imaging studies for dermoid cyst?
US or CT if necessary
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
List two hemangiomas that might mandate surgical intervention.
1. Subglottic hemangioma (airway constriction )
2. Eyelid hemangioma (visual impairment)