History & Exam
This history detail makes a neck mass more likely developmental than inflammatory.
present since birth/neonatal onset
This congenital lesion famously rises when the tongue comes out.
thyroglossal duct cyst
Fever + tender enlarged node + erythema most strongly suggest this category.
inflammatory/infectious lymphadenitis
First-line imaging for most palpable pediatric neck masses.
ultrasound
This neck location should make your malignancy radar jump.
supraclavicular region
Multiple tiny nodes that feel like buckshot are called this.
shotty lymphadenopathy
The most common congenital pediatric neck mass.
thyroglossal duct cyst
This disease pairs cervical lymphadenopathy with conjunctivitis and a strawberry tongue.
Kawasaki disease
CT with IV contrast is preferred when you suspect this deep neck complication.
retropharyngeal or deep neck abscess
Persistent lymph nodes over this size after empiric antibiotics deserve biopsy consideration.
>2 cm
A neck mass that enlarges after antibiotics should push you to consider this broad category.
neoplastic disease
Unlike thyroglossal duct cysts, these midline cysts usually move with the skin instead of swallowing.
dermoid/epidermoid cysts
Exposure to cat scratches or cat feces should make you send testing for these two infections.
cat-scratch disease (Bartonella henselae) and toxoplasmosis
MRI with gadolinium and/or Doppler is the gold standard for evaluating this lesion family.
vascular lesions/malformations
These constitutional symptoms earn the nickname “Type B symptoms.”
fever, malaise, weight loss, night sweats
A rapidly enlarging mass over days is usually this process; one growing over months–years suggests this opposite process.
inflammatory/infectious, versus benign neoplastic
The branchial cleft anomaly that accounts for ~95% of branchial lesions.
second branchial cleft anomaly
This atypical infection causes a painless fluctuant node with violaceous skin and eventual breakdown.
atypical mycobacterial infection
This procedure can avoid open biopsy and has >90% sensitivity in children.
fine-needle aspiration
This consistency should make you think malignancy: hard, rubbery, immobile—or this word.
fixed
Besides the neck itself, name two exam regions specifically worth checking because they may reveal the source of lymphadenopathy.
skin/scalp, ears, nose, oral cavity, thyroid, cranial nerves
This branchial anomaly syndrome association should trigger hearing and renal evaluation.
branchiootorenal syndrome
Name the three oral antibiotic choices suggested for empiric bacterial cervical lymphadenitis.
cephalexin, amoxicillin-clavulanate, and clindamycin
This imaging study should not be ordered for a thyroid mass because it may interfere with later therapy.
CT with contrast for thyroid mass
Your node has persisted >6 weeks, enlarged on antibiotics, and is firm and fixed. Your next move?
urgent referral to head and neck surgery ± biopsy