1. Radiological imaging of
pediatric neck masses.
Dr/ ABD ALLAH NAZEER. MD.

2. % of total
Congenital lesions 55%
Branchial cleft cyst 18%
Thyroglossal duct cyst 16%
Dermoid cyst 10%
Lymphangioma 8%
Hemangioma 2%
Teratoma
Bronchogenic cyst
Thymic cyst
Myelomeningocele
Inflammatory lesions 27%
Reactive lymphadenopathy 16%
Undetermined etiology 15%
Sinus histiocytosis 1%
Granulomatous disease 7%
Atypical mycobacteria 4%
Cat scratch disease 1%
Toxoplasmosis
Sarcoid
Suppurative lymphadenitis 2%
Sialadenitis 1%
Non-inflammatory benign Lesions 5%
Inclusion cyst 3%
Fibromatosis 2%
Keliod.
Benign neoplasms 3%
Neurofibroma 1%
Lipoma 1%
Lipoblastoma
Paraganglioma
Goiter
Benign mixed tumor
Osteoblastoma
Malignant neoplasms 11%
Lymphoma 8%
Hodgkin's 5%
Non-Hodgkin's 2%
Thyroid Carcinoma 1%
Rhabdomyosarcoma
Neuroblastoma
Fibrous histiocytoma
Acinic cell carcinoma
Histiocytosis X
Chloroma.
Pediatric Neck Masses:

7. Radiological imaging
X-Ray.
Ultrasound.
CT Scan.
MRI study.
PET Scan.
Fine aspiration.
Surgical biopsy.

8. Pediatric Neck Masses:
1. Congenital lesions.
2. Inflammatory lesions.
3. Non-inflammatory benign lesions.
4. Benign neoplasms.
5. Malignant neoplasms.

9. 1. Congenital Lesions
Branchial cleft cyst 18%
Thyroglossal duct cyst 16%
Dermoid cyst 10%
Lymphangioma 8%
Hemangioma 2%
Teratoma.
Bronchogenic cyst.
Thymic cyst.
Myelomeningocele.

11. Diagram for
Branchial
cleft cysts.

14. First Branchial Cleft Cyst.

15. First branchial cleft cyst. There is a T1-hypointense and T2-hyperintense
cystic lesion involving the superficial lobe of the right parotid gland, as
seen on axial T1- and T2-weighted sequences (A and B, respectively).

18. Second Branchial Cleft Cyst. Axial non-contrast MRI images (above) and
sagittal contrast-enhanced MRI images below. There is a cystic mass filled
with a simple fluid surrounded by a homogeneously enhancing thin-wall in
the right neck anteriorly. The cyst is located anterior to the right
sternocleidomastoid muscle and inferoposterior to the right parotid gland
and is most consistent with a second branchial cleft cyst.

19. Second branchial cleft cyst.

20. Secondary infected
branchial cleft cyst.

21. Two cases of third branchial cleft cysts.

22. Recurrent abscess arising from 3rd branchial cleft cyst. Coronal (A) and axial (B and C)
postcontrast CT images of the neck show a peripherally enhancing fluid collection
extending from the left retropharyngeal space, into the thyroid strap muscles on the left,
along the anterior and lateral margin of the left thyroid lobe deep to the
sternocleidomastoid muscle, representing abscess arising from 3rd branchial cleft cyst.

25. 2 cases of thyroglossal duct cyst.

26. Lingual thyroid.

27. Left sublingual plunging ranula.

29. Two cases dermoid cyst.

30. Epidermoid cyst. (A) The axial contrast-enhanced CT scan shows a cystic attenuation lesion
centered in the floor of the mouth. (B) The axial and (C) Sagittal MR T2-weighted image
reveals a well-defined T2 hyper-intense lesion in the floor of the mouth in the same patient.

32. Parapharyngeal Teratoma.

33. Huge Teratoma.

34. Teratoma with fat intensity at T1WI.

35. Giant Congenital Cervical Teratoma.

39. Lymphangioma or Cystic hygroma

40. Lymphangioma or Cystic hygroma.

41. U/S and MRI images for cystic hygroma.

42. Lymphangioma protruding from the neck.

44. Two cases of neck hemangioma.

45. Infantile hemangioma.

46. 2-month-old boy with infantile hemangioma of right parotid gland.

47. 2. Inflammatory Lesions
Reactive lymphadenopathy 16%
Undetermined etiology 15%
Sinus histiocytosis 1%
Granulomatous disease 7%
Atypical mycobacteria 4%
Cat scratch disease 1%
Toxoplasmosis
Sarcoid
Suppurative lymphadenitis 2%
Sialadenitis 1%

51. Two cases of retropharyngeal Space Abscess.

52. Retropharyngeal abscess.

53. Peri tonsillar Abscess.

54. Thyroid Abscess

55. A 2-year-old boy with acute Suppurative thyroiditis. Contrast-enhanced CT
shows a fluid collection (arrows) with internal gas (arrowhead) involving
left lobe of thyroid gland (open arrows) and adjacent soft tissue.

56. 3. Non-inflammatory Benign Lesions
Inclusion cyst 3%
Fibromatosis 2%
Keloid

57. Inclusion Cyst:
Acquired dermoid cysts result from a part of the skin
being traumatically implanted in the deeper layers after
ectopic formation of a dermal cyst lined with squamous
epithelium.
Congenital inclusion dermoid cysts form along the lines
of embryologic fusion and contain both dermal and
epidermal derivatives.
Dermoid cysts of the head and neck are thought to be
the congenital inclusion type.
many cysts originate from the infundibular portion of the
hair follicle, and the more general term, epidermoid cyst,
is favored.

58. Torticollis.

59. Fibromatosis Colli
SCM
Isoechoic mass
CT shows isodense
mass R side
Note normal SCM on L side.

60. 4. Benign Neoplasms:
Neurofibroma. 1%
Lipoma. 1%
Lipoblastoma.
Paraganglioma.
Goiter.
Benign mixed tumor.
Osteoblastoma.

61. Neurofibroma:
solitary lesion
Vs
part of the generalized syndrome of
neurofibromatosis
NF-1, aka von Recklinssghausen disease
NF-2,
Believed to arise from Schwann cell but
origin uncertain.

62. Neurofibroma.
T2 MRI
Central low T2 signal
is characteristic of
neurofibromas

63. Paraganglioma: Ultrasound with color Doppler, T1-weighted non-contrast MR and CECT

64. Lipoma & Lipoblastoma.
Rare benign mesynchymal tumor of embryonal fat
May clinically and radiologically mimic a hemangioma
Collections of lipoblasts –multivuolated w/ round nuclei
Lipoblastomatosis of the Neck.

65. Infiltrating lipoma of neck.

66. Lipoma in the right posterior cervical space.

67. Neonatal Goiter
CT shows large peripheral rim
enhancing, low attenuation
mass
1: 4000 live births
Female 2x = Male
Predominance
Delayed ossification at bone
ends

68. Child with diffuse goiter and intra-thoracic extension.

69. 5. Malignant Neoplasms
Lymphoma. 8%
Hodgkin's. 5%
Non-Hodgkin's. 2%
Thyroid Carcinoma. 1%
Rhabdomyosarcoma.
Neuroblastoma.
Fibrous histiocytoma.
Acinic cell carcinoma .
Histiocytosis X.
Chloroma.

70. Lymphoma.
Third most common pediatric cancer.
Incidence: 11-20 per million children.
Geographical variance – 50 % of
childhood cancers in equatorial Africa.
Due to high incidence of Burkett's
lymphoma.
Male predominance 2.5:1.

72. Two cases of Lymphoma.

73. Neuroblastoma, Mass (arrow) lateral to carotid artery (arrowhead).

74. Neuroblastoma. Axial proton-density-weighted image of the neck shows a
well-defined right neck mass in the carotid sheath deviating the carotid artery
and jugular vein anteriorly and mildly deviating the trachea to the left.

75. Rhabdomyosarcoma - CT

76. Rhabdomyosarcoma of the Masticator Space.

77. Chordoma exiting skull base and protruding anteriorly into cervical spine.

78. Malignant Fibrous Histiocytoma.

79. Conclusions:
Initial evaluation (H&P)
Congenital, infectious, benign, malignant
Beware of tuberculosis, cat scratch
disease, atypical infections
Beware of systemic symptoms
Beware the supraclavicular mass
Consider FNA or biopsy in the mass that
does not resolve with treatment.

80. Thank You.