Diagnosing Head & Neck Masses in Children

A head or neck mass is a lump or bump that develops on a child’s head or neck. These masses can vary in size and consistency, and can be red or pink, swollen, and tender. Often, a neck mass forms on the middle of the front 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 head or neck mass based on its location, size, consistency, and appearance.

Head and neck masses are common in children. Although they may be alarming to parents, they are usually not cancerous. They may appear in children ranging in age from infancy to adolescence. They are slightly more likely to affect children under age 5, because infections of all types are more common in young kids, and infections can cause an enlarged lymph node in the head or neck to form.

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

Causes of Head and Neck Masses

The most common cause of a head or neck mass is an enlarged lymph node located behind and beneath the jaw. The lymph node is a small organ of the immune system that traps viruses and bacteria and swells in response to an infection.

Infections such as the common cold or influenza 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 head or 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 their neck that grows larger over time, or becomes infected and grows rapidly. One common neck mass is a thyroglossal duct cyst, which develops just above the thyroid gland, which is in the front of the neck, just above the collarbone. Cysts, which vary in size, may be tender if they are infected.

Less commonly, a head or neck mass is a tumor, which is a growth that contains body tissue. A tumor may feel hard or soft, and can sometimes be tender. Most head or neck tumors in children are benign, meaning 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 head or neck mass is a cancerous tumor or a symptom of Hodgkin lymphoma or non-Hodgkin lymphoma. If your child is diagnosed with cancer, our ENT doctors partner with oncologists—cancer specialists—to provide essential care.

To determine the cause of a head or 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 head or neck mass first appeared, how quickly it has grown, and whether it causes any discomfort. They 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 tumor or other kind of head or neck mass.

Physical Exam

Your child’s doctor examines the head or 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 in the front center of the neck.

Doctors use their 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 them 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. The blood from a vein in your child’s arm is sent 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 may use ultrasound to determine whether a head or neck mass is a swollen gland, cyst, or tumor.

To perform an ultrasound, a technician moves a handheld device called a transducer gently across your child’s head and neck. The transducer sends the image gathered 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 do not 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 head and neck and helps the doctor assess the extent of inflammation caused by an infection.

If your doctor recommends surgery to remove a mass, CT images may be used to guide the procedure.

Biopsy

If the results of an imaging test suggest that a head or neck mass may be a tumor, your child’s doctor may recommend taking a tissue sample, called a biopsy, to send to a laboratory for testing. A pathologist—a doctor who studies diseases under a microscope—can confirm if a 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. The kind used depends 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.

If your doctor determines that a needle biopsy is not possible, an open biopsy is done instead. In this procedure, the doctor makes an incision in the head or 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 an open biopsy. Your child may seem drowsy for a few hours while the anesthesia wears off.

Results of a fine needle or open biopsy are available in about a week, and your child’s pediatric specialist calls you to discuss the results.