Multimodality Imaging Evaluation of the Pediatric Neck: Techniques and Spectrum of Findings

Abstract

Neck masses are a common finding in children and can present a difficult diagnostic challenge. These masses may represent a variety of conditions having a congenital, acquired inflammatory, neoplastic, or vascular origin. The fascial spaces and compartments of the neck provide an approach to differential diagnosis, and extensive knowledge of the anatomy and contents of each cervical compartment is mandatory in the diagnosis of pediatric neck lesions. Several imaging techniques, including radiography, gray-scale and Doppler ultrasonography, conventional and three-dimensional computed tomography, magnetic resonance (MR) imaging, and MR angiography, have been proposed for the evaluation of such lesions, and each has its own advantages and limitations. The imaging findings in 120 children who had been referred or treated for cervical lesions were retrospectively reviewed, and a systematic multimodality imaging approach to pediatric neck lesions based on the involvement of anatomic compartments of the cervical region was developed to increase diagnostic efficiency. Careful attention to clinical history and physical examination findings, along with knowledge of the embryologic features and anatomy of the cervical region and a multimodality imaging approach, is very helpful in the diagnosis and management of pediatric neck lesions.

The Role of Ultrasonography and Computerized Tomography in the Diagnosis of Pediatric Cystic Neck Swellings

“…Tracy and Muratore (8) considered branchial cleft anomalies as the second most common congenital head and neck anomalies found in children. Meuwly et al (5) study stated that over 90% of branchial cleft anomalies arise from the second branchial apparatus at the anteromedial border of the sternoceliomatoid muscle and this agreed with our study. 70% of the cysts showed posterior enhancement; 82% were unilocular and no sex predilection was reported.…”

“…US provides a rapid, relatively inexpensive, bedside, noninvasive technique that does not require sedation & does not involve radiation hazards; all of which are significant issues in the evaluation of various causes of neck swellings in the pediatric age group (4) . With its non invasive ability US helps to define the size and extent of localized superficial masses and to confirm their cystic or solid nature (5) . Color Doppler ultrasound can assess mass vascularity as well as evaluate patency of blood vessels, flow direction and analysis of flow velocity waveform which provides great help in establishing an accurate diagnosis (6) .…”

Fibromatosis colli in a neonate- A case report

“…At times calcification may be present 5 . Magnetic resonance imaging (MRI) shows decreased signal intensity of the mass on T2W images as compared to gradient-recalled T1W images, because of the presence of fibrous tissue 7 .…”

An Epidermal Cyst in the Floor of the Mouth: A Rare Presentation

“…Ultrasonographically they have solid and cystic structures within a heterogeneous mass, rarely with calcifications [5]. On CT scans, they are found to be moderately thin walled, unilocular masses which are filled with a homogeneous, hypoattenuating (0-18 HU) fluid material, with multiple hypoattenuating fat nodules, giving a "sack-of-marbles" appearance, which is virtually pathognomonic for the dermoid cysts in this location [1].…”