Lateral neck lumps

Abstract Lateral neck lumps are common in children and require a systematic approach to determine the diagnosis. Whilst the majority of lumps are benign, malignant pathology may present in the neck. The child's age, and location and characteristics of the lump may give strong clues as to its nature. Reactive hyperplasia causing cervical lymphadenopathy must be distinguished from other aetiologies, including malignancy. Focussed imaging may be required, in particular ultrasonography. Congenital abnormalities include lymphatic and vascular malformations, branchial remnants, and teratomas. While most infective causes of lymphadenitis are innocuous, the clinician should be aware of atypical mycobacterial lymphadenitis in a child as it occurs mostly between 2 and 6 years of life and requires drainage of the abscess, as well as curettage or removal of the subjacent causative lymph node. Malignancy tends to occur in older children. A definitive diagnosis, however, may require a biopsy of the lump.