CHAPTER 48 ■ NECK MASS CARLA PRUDEN, CONSTANCE M McANENEY INTRODUCTION Neck masses are a common concern in the pediatric population By definition, these include any visible or palpable swelling that disturbs the normal contour of the neck between the shoulder and the angle of the jaw Other than trauma, the three basic classifications of neck lesions are inflammatory, congenital, and neoplastic Inflammatory masses representing infectious changes in otherwise normal structures, such as lymphadenopathy and lymphadenitis, are the most common Congenital anatomic defects of the neck including cystic hygromas, branchial cleft cysts, hemangiomas, thyroglossal duct cysts, and dermoids, may be minimally apparent at birth, with progressive cyst formation over time Neoplastic lesions of the head and neck often involve the lymphatic system These are fairly uncommon, but must be ruled out With multiple potential etiologies, an organized approach to the history and physical examination of the head and neck, including a working understanding of the embryology, is important to facilitate proper diagnosis and treatment Many factors, ranging from aesthetics to concern for malignancy, may precipitate the initial emergency department (ED) visit Direct compression of vital structures (e.g., airway, cardiovascular structures, or cervical spinal cord) can cause a principal threat to life Rarely, systemic toxicity from progression of local infection or thyroid storm can cause uncompensated shock In this chapter, recognition of masses that represent true emergencies will be addressed first ( Table 48.1 ), followed by the approach to common, nonemergent lesions ( Table 48.2 ) Table 48.3 lists causes of neck masses in children by location INITIAL EVALUATION AND DECISION MAKING Initial history and physical examination should rapidly assess immediate threats to airway, breathing, circulation, and neurologic status The resultant clinical impression should guide immediate interventions and work up Children’s airways are small, and compression of vital structures may lead to significant distress Stridor, hoarseness, dysphagia, and drooling are ominous indications of airway compromise Respiratory or cardiovascular compromise may manifest as mental status changes