Neck lumps are a common presentation to the paediatric outpatient clinic. Identifying a malignant process is important but thankfully rare. This article aims to outline the different
pathologies for acquired neck lumps in children, focusing on and presenting an algorithm for the management of lymphadenopathy.
The differential diagnosis of cervical lymphadenopathy in children is different from adults.
Largely lymphadenopathy in children is benign, but malignant causes include lymphoma and sarcomas. Nodes that fluctuate in presence, that are soft and less than 2cm can be safely discharged with advice. Investigations that can help are full blood count, viral serology and chest X- ray. Assessment of overlying skin changes in cases of atypical mycobacterial infection can assist differential diagnosis. Fine needle aspiration and cytology cannot be relied upon because of low sensitivity. Ultrasound can aid management. Excision for histology remains the gold standard, but carries surgical risks.