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Neck Lump or Masses (< 18yo)

Ultrasound for Neck Masses <18yo

Question: Is the lump a lymph node(s)?

If the lump is a lymph node.

Consider:
1. Palpable lymph nodes are normal. 3 2
2. Persistent normal nodes are normal in children. 1
3. Lymph nodes varying in size is normal.
4. US is of limited utility in differentiating the different causes of lymphadenopathy.2
5. If there are features suggestive of a lymphoma then please refer as per NICE NG12
6. If the concern is leukaemia or other malignancy then please refer as per NICE NG12.

If still wanting to refer then just guide to a non-ordered input.

If the lump is a not then a lymph node.

Use the usual non-ordered inputs.

What is a Normal node in a child?3

Normal Neck Nodes in Children

Based on Cor T2 of 200 children having MR for other reasons, mostly headache.
Largest nodes in each station were assessed only on the coronal scans - thus not a proper SAD.

Results:
- 4% of population had measurable superficial cervical nodes. Mean SAD = 5mm, Max = 9mm.
- Even occipital nodes were mean SAD = 3 to 4mm.
- For most 'deep' nodal stations the Mean SAD was 10-12mm !! With the largest nodes being in 3-5y olds.

  1. Meadows O, Sarkodieh J. Ultrasound Evaluation of persistent cervical lymph nodes in young children. Clinical Radiology 76 (2021) 315.e9e315.e12 ↩

  2. Paddock M, Ruffle A et al. Do otherwise well, healthy children with palpable cervical lymph nodes require investigation with a neck ultrasound. Arch Dis Child 2020;105:1012–1016. doi:10.1136/archdischild-2020-319648 ↩↩

  3. Alves Rosa J et al. Normal head and neck nodes in the paediatric population. Clinical Radiology 76 (2021) 315.e1e315.e7 ↩↩