For children with neck masses that require surgery, the pediatric general surgery team at Johns Hopkins All Children’s in St. Petersburg, Florida, provides expert care.

The most common types of neck masses we treat are enlarged lymph nodes and congenital abnormalities like epidermoid cysts, thyroglossal duct cyst and branchial cleft cyst.

Some of these cysts are just under the skin and others have tracts that extend into the neck and need to be removed along with the cyst. If cysts are infected when they are first diagnosed, drainage of the infection and treatment with antibiotics may need to be done first and surgical removal of the cyst at a later time once the infection is resolved. We also treat masses in the thyroid and parathyroid glands.

Conditions We Treat

Congenital (present at birth)

• Thyroglossal duct cyst: A midline neck mass that moves with swallowing or tongue protrusion. It may present after a child has an upper respiratory infection and is the most common congenital neck mass
• Branchial cleft cyst: A lump that usually appears on the side of the neck, in front of the long muscle that runs diagonally along the side of the neck (called the sternocleidomastoid muscle).
• Dermoid cyst: Generally forms on the midline of the neck and has a soft, doughy consistency.
• Lymphatic malformation (cystic hygroma): A soft and compressible mass that may enlarge rapidly with infection. It often transilluminates, which means that light can shine through it.
• Hemangioma: A vascular lesion appearing in infancy with a possible red/blue discoloration.

Inflammatory/Infectious

• Reactive cervical lymphadenopathy: This is a tender mass that can move and is associated with a viral upper respiratory infection.
• Bacterial lymphadenitis: A tender mass that is abnormally red, irritated or inflamed. It is associated with a fever and possible abscess formation.
• Cat scratch disease: An enlarged, tender mass that forms with history of being scratched by a cat.
• Infectious mononucleosis: An enlarged mass associated with fatigue, fever and sore throat.

Neoplastic (abnormal growth)

• Benign tumors including lipoma, fibroma and neurofibroma

Malignant (cancerous) causes

• Hodgkin and non-Hodgkin lymphoma: These conditions are associated with firm, fixed nodes, that can be in the neck or the region above the collarbone. They are associated with weight loss, night sweats and persistent fever.

Our Approach to Treatment

To diagnose a neck mass, your child’s provider will conduct a physical exam to assess the size, mobility and consistency of the mass as well as any changes to the skin. Testing that can include ultrasound, CT or MRI is also done, as well as blood tests, to accurately diagnose the type of neck mass.

Treatment depends on the type of neck mass and your child’s individual condition. Some may not need surgery immediately and may be observed for changes. Others always require surgery to remove the mass. If a mass is suspected to be malignant, a biopsy is done to remove the mass and test whether it is malignant.

These procedures are done under general anesthesia, often on an outpatient basis.

What to Expect

Our team will guide you and your child through each step of the process. This includes your child’s pre-operative consultation, anything you need to do to prepare for your child’s surgery, and what to expect the day of. Learn more about what happens before and on the day of your child’s surgery.

We also offer a number of other resources and support services for families. Learn more about some of the resources available to your family.

Most patients are discharged the day of surgery. Thyroid and parathyroid surgery patients generally stay overnight following surgery and go home the next day. Pain around the incision is minimized with local anesthesia injected around the incision at the end of the operation and is easily controlled with pain medicine prescribed by the doctor.

The doctor will specify how long activity needs to be restricted. After thyroid and parathyroid surgery, some blood tests may be necessary to check on function of remaining glands, and thyroid hormone or calcium may be prescribed.