Radiological imaging of pediatric neck masses.

Dr/ ABD ALLAH NAZEER. MD.

% of totalCongenital lesions 55%Branchial cleft cyst 18%Thyroglossal duct cyst 16%Dermoid cyst 10%Lymphangioma 8%Hemangioma 2%Teratoma Bronchogenic cystThymic 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 ParagangliomaGoiter Benign mixed tumorOsteoblastoma Malignant neoplasms 11%Lymphoma 8%Hodgkin's 5%Non-Hodgkin's 2%Thyroid Carcinoma 1%RhabdomyosarcomaNeuroblastoma Fibrous histiocytomaAcinic cell carcinomaHistiocytosis XChloroma.

Pediatric Neck Masses:

Radiological imaging

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

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

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

Diagram for Branchial cleft cysts.

First Branchial Cleft Cyst.

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).

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.

Second branchial cleft cyst.

Secondary infected branchial cleft cyst.

Two cases of third branchial cleft cysts.

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.

2 cases of thyroglossal duct cyst.

Lingual thyroid.

Left sublingual plunging ranula.

Two cases dermoid cyst.

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.

Parapharyngeal Teratoma.

Huge Teratoma.

Teratoma with fat intensity at T1WI.

Giant Congenital Cervical Teratoma.

Lymphangioma or Cystic hygroma

Lymphangioma or Cystic hygroma.

U/S and MRI images for cystic hygroma.

Lymphangioma protruding from the neck.

Two cases of neck hemangioma.

Infantile hemangioma.

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

2. Inflammatory LesionsReactive lymphadenopathy 16%Undetermined etiology 15%Sinus histiocytosis 1%Granulomatous disease 7%Atypical mycobacteria 4%Cat scratch disease 1%Toxoplasmosis SarcoidSuppurative lymphadenitis 2%Sialadenitis 1%

Two cases of retropharyngeal Space Abscess.

Retropharyngeal abscess.

Peri tonsillar Abscess.

Thyroid Abscess

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.

3. Non-inflammatory Benign Lesions

Inclusion cyst 3%Fibromatosis 2%Keloid

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 linesof embryologic fusion and contain both dermal and epidermal derivatives.Dermoid cysts of the head and neck are thought to bethe congenital inclusion type.

many cysts originate from the infundibular portion of the hair follicle, and the more general term, epidermoid cyst, is favored.

Torticollis.

Fibromatosis ColliSCMIsoechoic massCT shows isodensemass R sideNote normal SCM on L side.

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

Neurofibroma:solitary lesionVspart of the generalized syndrome ofneurofibromatosisNF-1, aka von Recklinssghausen diseaseNF-2,Believed to arise from Schwann cell but origin uncertain.

Neurofibroma.

T2 MRICentral low T2 signal is characteristic ofneurofibromas

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

Lipoma & Lipoblastoma.Rare benign mesynchymal tumor of embryonal fatMay clinically and radiologically mimic a hemangiomaCollections of lipoblasts –multivuolated w/ round nuclei

Lipoblastomatosis of the Neck.

Infiltrating lipoma of neck.

Lipoma in the right posterior cervical space.

Neonatal GoiterCT shows large peripheral rimenhancing, low attenuationmass 1: 4000 live birthsFemale 2x = MalePredominanceDelayed ossification at bone ends

Child with diffuse goiter and intra-thoracic extension.

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

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

Two cases of Lymphoma.

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

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.

Rhabdomyosarcoma - CT

Rhabdomyosarcoma of the Masticator Space.

Chordoma exiting skull base and protruding anteriorly into cervical spine.

Malignant Fibrous Histiocytoma.

Conclusions:Initial evaluation (H&P)Congenital, infectious, benign, malignantBeware of tuberculosis, cat scratchdisease, atypical infectionsBeware of systemic symptomsBeware the supraclavicular massConsider FNA or biopsy in the mass thatdoes not resolve with treatment.

Thank You.