Ultrasonography in the Treatment of a Pediatric Midline Neck Mass

Abstract

Ultrasonography is helpful in determining the pediatric midline neck masses that need to be removed surgically. It is less helpful in determining the exact pathologic characteristics of the lesion.

Ultrasound to differentiate thyroglossal duct cysts and dermoid cysts in children

“…Anterior neck masses in children are most commonly TGDC, DC, or reactive lymph nodes. Ultrasonography is preferred over computed tomography and magnetic resonance imaging for evaluation of these masses in children because it is less expensive, has no ionizing radiation, is noninvasive, and does not require sedation . Although ultrasound is quite good at differentiating cystic (TGDC and DC) from solid (lymph node) structures based on density and blood flow, historically, it has not proven very useful for differentiating TGDC from DC.…”

“…Previous authors have described ultrasound characteristics of TGDC as being well‐circumscribed, homogenous, posteriorly enhancing cysts located above the level of the thyroid gland; and they have described DC as being well‐circumscribed, thin‐walled, heterogeneous cysts . Unfortunately, this ultrasound distinction has not been consistent in the literature . Some studies presented conflicting results and others suggested that ultrasound has limited prognostic value .…”

“…6,7 Unfortunately, this ultrasound distinction has not been consistent in the literature. 8,9 Some studies presented conflicting results and others suggested that ultrasound has limited prognostic value. [10][11][12] The inability to differentiate between TGDC and DC is problematic to the surgeon because it can result in difficulty consenting patients regarding the extent of surgery as well as planning the length of the operative procedure.…”

Neck Masses in Children

“…9 It was found that postsurgical pathology diagnosis concurred with 48.4% of preoperative diagnosis determined by US. Increased white blood count may suggest acute bacterial infection such as lymphadenitis.…”

“…Increased white blood count may suggest acute bacterial infection such as lymphadenitis. 9 US is the preferred imaging modality for diagnosing thyroglossal duct cyst compared with computed tomography (CT) because of its ability to differentiate thyroglossal duct cysts from other cervical masses. An ultrasound (US) is commonly used initially in children because of being the least invasive.…”