Neck lumps in children

There is a wide differentials for acute or chronic neck masses in children.

History:

– Onset, duration & progress of lump

– Size, location, overlying skin

– Intermittent, static or progressive?

– Any recent changes to the lump?

– Any fever, cough, sore throat?

– Trauma to neck?

– Any immunocompromised?

– Exposure to cats? TB?

– Any other lumps elsewhere?

– Weightloss, night fever, tiredness?

– Any known illness?

Examination:

Local exam:

– Location, Size, Shape

– Smooth/ irregular?

– Underlying structure

– Overlying skin appearance

– Tender? Warm?

– Pulsatile? Fluctuant?

– Moving with deglutination?

Systemic exam:

– Child looking unwell? Pale?

– Rashes? Bruising?

– Lymph nodes? hard or matted?

– Hepatospleenomegaly?

– Stridor? Drooling?

– Torticollis?

– Tachypnoea? Resp distress?

– Gait & Coordination

Red flags:

– Stridor

– Dysphagia/ drooling

(Urgent ENT ref if above)

– Pallor, bruising, bone pain

– Night seats, weightloss

– Unwell child with fever

– Rapidly enlarging mass

– Hepatospleenomegaly

Investigations:

(Guided by likely differential)

– FBC, CRP, Blood Culture

– Throat Swab

– Appropriate imaging USS, CXR, MRI

– Consider FNAC/ Biopsy

– Serology for CMV, EBV, HIV

Management:

Depends on cause

Urgent ENT referral if airway at risk

Urgent referral if malignancy suspected

If infective lymphadenitis, trial of Coamoxyclav & review in 48h

If fluctuant & abscess likely, may need draining after USS confirmation

If non-tuberculous mycobacteria suspected, excision biopsy (& not FNAC)