Lateral Neck Mass

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					Lateral Neck Mass

       Justin Rufener, MS4
   Diagnostic Radiology Rotation
   6 month old male
   Two days ago, mom noticed lump on right
    side of neck
   Fevers to 101 last two days
   No URI symptoms
   No other bumps or masses
   No easy bruising, bleeding
Physical Exam Findings
   Afebrile
   4 x 6 cm right neck mass
   Below right ear
   Just posterior to SCM
   Firm, slightly tender
   No overlying erythema or skin changes
   No other lymphadenopathy or masses
   Remainder of exam normal
Posterior Neck Mass
       Radiographic findings

   bulky soft tissue
    mass in right neck
   posterior to vessels
   deep to SCM
   invading
    subcutaneous fat
   multiple posterior
    lymph nodes on left
        Differential Diagnosis

            0-40: Inflammatory>Congenital>Neoplastic
             40+    Neoplastic>Inflammatory>Congenital

                Medial/Midline:    Thyroglossal duct cyst

                Lateral: Neoplasm (lymphoma, mets)
                        Lymphangioma, branchial cleft cyst
DDx in this patient
   Lymphangioma
   Branchial cleft cyst
   Malignancy
   Lymphadenopathy/infection
   Lymphatic malformations
   Posterior cervical space
    most common location
   Variable from single cyst to
   CT shows fluid filled spaces
    with surrounding
    connective tissue
          Branchial Cleft Cyst
   Incomplete obliteration of
    cervical sinus of his
   Second branchial cleft cyst
    most common
   Location: ant to SCM, lateral
    to thyroid
   Single, fluid filled cyst on CT
   Can become
    inflamed/enlarged with colds
   Less common, but worrisome etiology
   Not usually cystic in appearance
   Most common types in children:
       Neuroblastoma
       Lymphoma
       Rhabdomyosarcoma
Infectious Lymphadenopathy
   Multiple etiologies:
       Viral: EBV, CMV
       Bacterial: Staph, Group A Strep
       Cat Scratch: Bartonella
       Scrofula (mycobacterium)
        This patient: key findings
   Recent fever
   New onset enlargement
   Location: posterior cervical lymph nodes
   CT appearance typical of lymphadenopathy
       enhancing rim, necrotic center
       distortion of anatomy
       invasion of surrounding fat, SCM
   Cannot rule out infected lymphangioma or
Final Diagnosis
   Patient taken to OR for open biopsy
   Findings: enlarged lymph node with pus
   Culture: Staph aureus
   Final Dx:
       Supperative Lymphadenopathy
       ACR 27.20