Overview
Most children are likely to have benign causes of neck lumps such as reactive lymphadenopathy. Malignancy is rare, but the most common malignancies presenting with neck lumps in children include lymphomas, thyroid cancer, and soft tissue sarcomas. The likelihood of malignancy increases with age, especially in adults >40 years old.
Differential Diagnoses
Reactive lymphadenopathy
- Most common cause of neck swellings
- Acute, multiple, small tender and mobile lymph nodes bilaterally which may be red and warm
- There may be a history of infection
- Usually subsides after 3-6 weeks following infection
Thyroglossal cyst
- Most common congenital cyst
- Usually seen in young children
- May grow rapidly after an upper respiratory tract infection
- Usually well-defined, midline, non-tender cystic lump that moves upward when the person swallows or sticks out their tongue
- May become warm, erythematous, and tender if infected
Skin infection
- Infection may include abscesses or an infected dermoid cyst
- Warmth, erythema of the overlying skin, localised swelling, tenderness
- Skin abscesses may present as fluctuant, painful masses
Cystic hygroma (lymphangioma)
- Poorly-defined fluctuant mass that transilluminates
- Usually seen in the posterior triangle of the neck and present from birth
Branchial cyst
- Usually seen in children/adolescents
- Painless, slow-growing, smooth, and fluctuant swelling in the lateral neck
- Usually at the junction of the upper 1/3 and lower 2/3 of the anterior sternocleidomastoid muscle border
Dermoid cyst
- Usually seen in children and young adults
- Superficial midline lump that is well-defined, soft, and painless
- Tethered to the underlying skin and does not move with tongue protrusion (unlike a thyroglossal cyst)
Malignancy
- Rubbery and painless lymphadenopathy
- In general, hard or firm and immobile lumps or tethered lumps may be concerning
- The lump may grow rapidly and lymphoma may be mobile, and lymph node metastases may be firm and fixed
- There may be associated hepatomegaly and/or splenomegaly
- Systemic symptoms e.g. fever/night sweats/weight loss may be present
Infantile haemangioma (strawberry naevus)
- Seen shortly after birth as a flat/slightly raised pink patch on the overlying skin of the head or neck
- Initially grows rapidly and then shrinks and disappears spontaneously over a few months
Neck venous malformation
- Seen at birth with an irregular, compressible neck mass with blueish overlying skin
- May be more obvious when an infant is straining, crying, or bearing down
- They grow with the child and tend to increase in size as the child grows
- They may expand rapidly with trauma or hormonal changes
