Diagnosing Neck Masses in Children

A neck mass is a lump or bump that develops on a child’s neck. Neck masses can vary in size and consistency, and may be red or pink, swollen, and tender. Often, a neck mass forms on the front middle part of the neck or just below the jaw, but it may appear on any part of the neck.

At Hassenfeld Children’s Hospital at NYU Langone, otolaryngologists—also known as ear, nose, and throat (ENT) doctors—identify the cause of a neck mass based on its location, size, consistency, and appearance.

Neck masses in children are common. Although they may be alarming to parents, they are usually not cancerous or even serious. They may appear in children ranging in age from infancy to adolescence. They are slightly more likely to affect children under age five because infections of all types are more common in young kids, and a neck mass may form as the result of an infection.

Even though neck masses are rarely a sign of a serious health problem, any mass should be evaluated by a doctor right away. This ensures that, if needed, our doctors can begin treatment immediately.

Causes of Neck Masses

Many medical conditions can lead to a neck mass. The most common cause is an enlarged lymph node located behind and beneath the jaw. A lymph node is a small immune system organ that traps viruses and bacteria and swells in response to an infection.

The common cold, a sinus infection, or—more rarely—a condition such as tuberculosis may cause one or more lymph nodes in the neck to swell. An infection caused by an insect bite or cat scratch may have the same effect.

If a neck mass is caused by an infection, symptoms may include redness, tenderness, warmth to the touch, and fever.

Some children are born with a cyst—a fluid-filled sac—on the neck that grows larger over time, or becomes infected and grows rapidly. The most common is a thyroglossal duct cyst, which develops just above the thyroid gland, located in the front of the neck just above the collarbone. Cysts vary in size and may be tender if they are infected.

Less commonly, a neck mass is a tumor, which is a growth that contains bodily tissue. A tumor may feel hard or soft, and can sometimes be tender. Most neck tumors in children are benign, or noncancerous. Common benign tumors include neurofibromas, which usually develop as the result of neurofibromatosis, a rare genetic disorder that causes tumors to form on nerve tissue. A neurofibroma may appear as a single fleshy mass or multiple small lumps in the same area.

In rare instances, a neck mass is a cancerous tumor or lymphoma, a blood cell cancer that may cause the lymph nodes to swell. If your child is diagnosed with cancer, our ENT doctors partner with oncologists—cancer specialists—to provide the care he or she needs.

To determine the cause of a neck mass, your child’s doctor takes a medical history, then orders one or more tests.

Medical History

A doctor asks about your child’s health and symptoms, including when the neck mass first appeared, how quickly it has grown, and whether it causes any discomfort. He or she may also ask if your child has had any trouble breathing or swallowing.

If your child has recently been bitten by an insect or scratched by a cat, tell the doctor. These minor injuries can sometimes result in a serious infection.

Be sure to tell your pediatrician about any other medical conditions your child has and whether anyone else in your family has had a neck mass or tumor.

Physical Exam

Your child’s doctor examines the neck mass, noting its size and shape, and checks for redness, tenderness, and warmth. Specialists identify the location of the mass in relationship to the glands and lymph nodes beneath the skin. For instance, some neck masses develop on the thyroid gland, which is located in the front center of the neck.

A doctor uses his or her fingers to evaluate whether a mass is hard or soft and whether it moves beneath the skin or is part of an underlying structure, such as a gland. This helps the doctor differentiate between a growth and an enlarged gland such as a lymph node.

Blood Tests

Occasionally, a doctor may recommend a blood test to determine whether an infection is causing the lymph nodes to swell. He or she draws blood from a vein in your child’s arm and sends it to a laboratory for testing. Test results are usually available within one week, at which time your child’s doctor calls you to discuss next steps.

Ultrasound

An ultrasound, also called a sonogram, is an imaging test that uses sound waves to create images of structures in the body. Doctors use ultrasound to determine whether a neck mass is a swollen gland, cyst, or tumor.

To perform an ultrasound, a technician uses a handheld device called a transducer. He or she moves the device gently across your child’s neck, and the transducer sends the image to a computer monitor.

MRI Scan

An MRI scan uses a magnetic field and radio waves to create computerized, two- and three-dimensional images of the body. A doctor may recommend an MRI if ultrasound images don’t provide enough detail to confirm a diagnosis.

CT Scan

A CT scan uses X-rays and a computer to generate detailed cross-sectional images of the body. This test reveals any masses in the neck and helps the doctor assess the extent of inflammation caused by an infection.

If your doctor recommends surgery to remove a mass, he or she may use CT images to guide the procedure.

Biopsy

If the results of an imaging test suggest that a neck mass may be a tumor, your child’s doctor may recommend taking a tissue sample, or biopsy, to send to a laboratory for testing. A pathologist—a doctor who studies diseases under a microscope—can confirm if a neck mass is benign or cancerous and provide information about what type of tumor it is.

There are two types of biopsy that your child’s doctor may perform. He or she makes the decision about which approach to use based on the age of the child and the size and location of the mass. In the first approach, known as fine needle aspiration, a doctor inserts a thin needle into the mass and removes a small tissue sample. This procedure is often performed in a doctor’s office using local anesthesia. If a child has trouble sitting still, sedation may be used.

Sometimes a doctor determines that a needle biopsy isn’t possible, and he or she performs an open biopsy. In this procedure, the doctor makes an incision in the neck to remove a small piece of tissue from the mass. The incision is closed with stitches that dissolve on their own. Usually, this procedure is performed in a hospital using general anesthesia.

You may bring your child home within hours of the procedure. After the biopsy, your child may seem drowsy for a few hours while the anesthesia wears off. Results of the biopsy are available in about a week, and your child’s pediatric specialist calls you to discuss the results.