Cervical Lumps - Paediatrics

Cervical Lumps

·        99% of general neck lumps are lymph nodes:

o   Large nodes can take up to 6 – 8 weeks to go down

o   Three types:

§  Reactive hyperplasia: due to infection, not painful

§  Acute lymphadenitis: 

·        Acutely tender, erythematous mass with accompanying fever, usually settle with rest/analgesia

·        Results from URTI, cellulitis or other skin infections

·        Cervical lymphadenitis: S aureus or S pyogenes

·        Management: antibiotics and/or drainage 

§  Lymph node abscess: lymphadenitis may progress to abscess. Doughy feeling. Overlying skin erythematous. If raised, red and soft ®? Staph abscess ® flucloxacillin (always on an empty stomach). Augmentin for Strep abscess. Otherwise excise and drain under GA 

o   Rare causes of lymph node enlargement: Consider if subacute, minimal tenderness, fixed or overlying skin changes consider:

§  Cat-scratch disease

§  Toxoplasmosis 

§  Cutaneous Tb (collar stud abscess, bruised looking, no systemic symptoms, non-tender, tethered to skin, 6 mths to 5 years): excision, Mantoux and chest x-ray 

§  Hodgkin‟s Lymphoma: Child > 5, rapid enlargement, rubbery spherical lymph non-tender nodes, night sweats, fever, weight loss, lymphadenopathy elsewhere, splenomegaly

·        Lateral Neck Lumps: branchial cysts and branchial sinuses

·        Midline Neck Swellings:

o   Thyroglossal Cysts:

§  80% of midline cervical lumps

§  Peaks in pre-school child and young adulthood

§  Swelling near the hyoid that moves with swallowing or when pokes tongue out

§  May trans-illuminate

§  Early referral: get it out before it becomes infected

§  Treatment: surgery (Sistrunk procedure) and excision of the tract

o   Submental nodes: Usually superficial and anterior.  Check mouth for primary infection (eg ulcer) 

o   Dermoid Cysts: Common at the corner of the eyebrow (external angular dermoid). In the cervical region they are subcutaneous and mobile, and appear yellowish. Require excision

o   Ectopic Thyroid: Rare.  May be only thyroid tissue.  Tend to become hypothyroid