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Neck masses are common in childhood, and although most are benign, malignancy must remain a primary consideration. Among 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 While diagnosis is challenging, differentiating neck masses into inflammatory, congenital, or a neoplastic category is the first step toward diagnosis.



A thorough history and physical examination help narrow the broad differential for cervical lymphadenopathy. Both acuity and laterality of node swelling are helpful for diagnosis. Acute bilateral lymph nodes are typically due to a viral infection, 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 etiologies (Tables 125-1 and 125-2). Carefully document the features (size, location) 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 125-1Key Features From History
TABLE 125-2Key Features on Examination

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