Neck lumps Paeds

When to refer:

Size Matters: over 2 cm is suspicious

If acute abscess suspected refer urgently for medical care-usually antibiotic treatment.If chronic and no suspicious features, reassure. If unsure, organize USS neck.
If general suspicion of lymphoma etc., refer haemato-oncology for review. If biopsy is indicated, child will be discussed with ENT.
If rapid enlargement (not acute infection) refer urgently to haematology.
If unsure of pathology of midline lesion (e.g. thyroglossal duct cyst, branchial anomalies etc.) consider neck USS and consider referral to ENT.

If positive viral serology, consider referral to medical paediatrics.

General Practice Management

Assessment 

• Underlying pathology
  • URTI
  • Eczema
  • AOM
  • Teething
  • etc.
• Size
  • Preferably measured
  • LN under 2 cm are normal
• Number of LN
  • Several enlarged LN are suspicious
• Duration and fluctuation
  • LN do fluctuate with acute infections
  • Longstanding static LN are normal
  • After acute infections LN can take months to regress to normal size
• Position
  • Supraclavicular fossa is suspicious
• Associated symptoms
  • Fevers, night sweats, generally unwell, “just not herself” without any obvious cause is suspicious
• Other LN
  • Axilla, groin, etc.
  • If present and enlarged are suspicious

• Antibiotics if acute cervical lymphadenitis is suspected
• Consider need for bloods (FBC, U&E, LFTs, CRP, Viral serology – EBV, CMV, Toxoplasma, Cat scratch) and USS. RHSC radiology accept direct GP referrals for USS neck.
• Generalised lymphadenopathy and multiple/bilateral sub-centimeter lymph nodes in otherwise well children should not be referred to ENT. ; Consider General Paediatric referral if concerned or refer directly for outpatient neck ultrasound to confirm benign reactive nature and permit parental reassurance.
• Consider General Paediatric referral if concerned.
• GP can refer directly for outpatient neck ultrasound to confirm benign reactive nature to permit parental reassurance.