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Neck Masses in Children

By Udayan K. Shah, MD, Professor;Chief, Division of Otolaryngology, Sidney Kimmel Medical College at Thomas Jefferson University;Nemours/A.I. duPont Hospital for Children

Neck masses are swellings that change the shape of the neck.

Neck masses are extremely common among children. The most common cause is one or more enlarged lymph nodes (see Neck Lump). A lymph node may enlarge for the following reasons:

Sometimes neck masses are caused by a cyst (a fluid-filled sac) that has been present from birth but is noticed only after it has become inflamed or infected. Neck masses may also result from swelling due to a neck injury, inflammation of the salivary glands, or noncancerous (benign) tumors. Rarely, lymphoma, a thyroid tumor, or another cancerous (malignant) tumor is the cause.

Most neck masses cause no symptoms and are of greater concern to parents than to the children who have them. However, infected lymph nodes or cysts are tender and painful and may cause a fever.

Diagnosis

  • Imaging, swabs, blood tests, and tuberculosis skin tests

  • Thyroid tests

  • Biopsy

Because many neck masses are caused by viral infections and disappear without treatment, tests are usually not needed unless a mass lasts for several weeks.

However, doctors may take a swab from the back of the throat to test for a bacterial infection, or they may do blood tests to look for such disorders as infectious mononucleosis, leukemia, hyperthyroidism, or bleeding problems.

Doctors may also take x-rays of the chest and use computed tomography (CT) or magnetic resonance imaging (MRI) of the head and neck to determine whether the mass is a tumor or a cyst and to determine more precisely how big it is and to where it extends. Ultrasonography may be done to determine whether a mass in the neck is a cyst.

A skin test may be done to check for tuberculosis. A piece of the mass may be removed and examined (biopsy) to determine whether a cancerous tumor is present.

Other tests, such as use of a viewing tube to examine the nose, throat, and larynx (called nasopharyngolaryngoscopy); lungs (bronchoscopy); or esophagus (esophagoscopy) may be needed.

Treatment

  • Depends on the cause

Treatment of neck masses depends on the cause. Antibiotics are useful for infected lymph nodes and other bacterial infections. If antibiotics are not effective, surgery may be needed.

Masses caused by viral infections and swelling due to injury gradually disappear with time.

Tumors and cysts usually require surgery.