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Neck masses are common in childhood, and although most are benign, malignancy is always a primary consideration. Correct diagnosis is challenging, but differentiating neck masses into inflammatory, congenital, or neoplastic categories is the first step toward diagnosis.

In patients referred to tertiary centers for surgical excision of a cervical lesion, 90% to 96% of lesions are benign and are predominantly congenital.1,2



A thorough history and physical examination will narrow the broad differential for cervical lymphadenopathy. The acuity and laterality of node swelling are helpful for diagnosis. Typically, acute bilateral lymph nodes are due to a viral cause, acute unilateral nodes are due to a bacterial cause, and subacute/chronic nodes (>4 to 6 weeks) are due to granulomatous bacteria or noninfectious causes. This framework is most effective for diagnosis when combined with the general and specific features of different causes (Tables 122-1 and 122-2). Carefully record the features of all head and neck masses for future comparison. Lymph node location and characteristics give clues based on lymphatic drainage patterns. Look for systemic disease by assessing for generalized lymphadenopathy, hepatosplenomegaly, testicular masses and/or enlargement in males, and the child's overall condition.

TABLE 122-1Key Features from History
TABLE 122-2Key Features on Examination

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