Neck Masses

Midline Congenital

• thyroid/goiter
• thyroglossal duct cyst: not detected during infanct, often present with infection. Stick tongue out
• dermoid cysts: if cervical, typically midline
• teratoma, can occur anywhere

Lateral Congenital

• branchial cleft (90% 2nd cleft): cyst (grows with URI), sinus, fistula; along anterior border of SCM, to posterior tonsillar pillars
• foregut cyst, rare: can drain to ear canal
• cystic hygroma = lymphangiomas, dx in utero
• teratoma, can occur anywhere
• hemangioma, anywhere. Can transilluminate it. A beard distribution is assoc with airway hemangiomas. Hemangioma regression: 50% by age 5, 70% by 7, 90% by 9. (Compare to vascular tumors which are fixed, present at birth and are non blanching ie port-wine, sturge-weber). IFN for hemangiomas: side effect spastic diplegia.

Non-congenital, acquired

• lymph nodes, lymphadenitis: if < 12 yo, LN < 1 cm nl. In adults, < 3-5 mm. After infxn, takes months to subside.
• infectious: TB, sarcoid, fungal, cat-scratch (bartonella), more often assoc with kittens < 12 mo, cat-scratch assoc with HSP
• rhabdosarcoma
• lymphoma
• NF
• neuroblastoma
• ranula = salivary duct obstruction