• 0-20 years

  • causes:

    • congenital

    • inflammatory

    • lymphoma

    • tuberculosis

  • most are benign in children (reverse applies to adults)

  • suspicious nodes are >2.5cm with firmer consistency than normal

  • less mobility

red flags

>40yo especially >70yo

nodes >2.5cm

Nodes >3-4cm ?malignancy

tender mass

purple discoloration (collar-stud abscess)

single, gradually enlarging node

fixed to skin without punctum

associated dysphagia

hard midline thyroid lump

patient at risk of malignancy

Strenomastoid tumour/fibrosis

  • hard painless lump 2-3cm

    • within stermomastoid muscle

  • tight and shortened sternomastoid muscle

  • usually not observed @ birthappears at 20-30d of age

  • associated torticollis

    • head turned away from tumour

  • restricted head rotation to side of tumour

  • most tumours resolve spont. within i yr

  • child referred to a phsyio early

  • gently massage lump and stretch neck toward tumour

  • surgery if shortened muscle if persistant - best \<12mo

  • older children present with torticollis

    • tight short fibrous SCM

    • rotation of head to affected side

    • hemihypoplasia of face

    • wasted ipsilateral trapezius

    • requires surgery

Thyroglossal cyst

  • most common childhood midline neck swelling

  • moves with swallowing and tongue protrusion

  • prone to infection

Lumphatic malformation/lymphangioma

  • soft cystic tumours of neck, face or roal cavity

  • resemble clusters of vesicles

  • often poorly localised

  • visible red dots

    • haemangiomatous inclusions

  • if located floor of mouth/peripharyngeal area

    • endanger airway

    • ppt. emergency requiring surgery

Myobacterium avium-intracellularae scrofulaceium lymphadenitis

  • 2-3yo

  • chornic cervical lumphadenitis and collar stud abscesses

  • often unrecognised

  • painless swelling

  • nodes enlarge 4-6wks prior to reupting in to ‘cold’ abscess

  • overlying skin has a purplish discolouration

  • common sites;

    • submandibular

    • tonsillar

    • pre-auricular nodes

  • unilateral

  • no pulmonary involvemment

  • unresponsive to antimicrobials