🧬 Congenital Masses
• Thyroglossal duct cyst: midline, moves with tongue protrusion
• Branchial cleft cyst: lateral neck, anterior border of SCM
• Cystic hygroma (lymphangioma): posterior triangle, soft, transilluminates, associated with Turner/Noonan
• Dermoid cyst: midline, firm, rubbery
• Teratoma: midline/paramedian, calcifications
🦠 Acquired/Inflammatory
• Lymphadenitis: tender, reactive (viral/bacterial)
• Suppurative: S. aureus, Group A strep
• Cat-scratch disease (Bartonella): granulomatous, preauricular
• Atypical mycobacteria: chronic, violaceous
⚠️ Malignant Red Flags
• Rapidly enlarging, painless mass
• Constitutional symptoms: fever, night sweats, weight loss
• Hard, fixed, non-tender nodes
• Supraclavicular location
• Rhabdomyosarcoma, neuroblastoma, lymphoma
🦋 Thyroid & Other
• Goiter: midline, moves with swallowing
• Hashimoto thyroiditis: most common thyroid disease in children
• Graves disease: hyperthyroidism, exophthalmos
• Cold nodule: risk of malignancy (papillary/follicular)
📌 Decision strategy: Location (midline vs lateral, anterior vs posterior triangle), consistency, chronicity, and associated symptoms guide evaluation. Ultrasound is initial imaging. Fine needle aspiration for suspicious lesions.