EU Radiology: Ultrasound is first-line tool for pediatric neck masses
Ultrasound should be the primary modality for imaging children with an acute inflammatory neck mass, according to a study in the October issue of European Radiology.

Katya Rozovsky, MD, from the department of radiology at Hadassah-Hebrew University Medical Center in Jerusalem, and colleagues, wrote that inflammatory neck masses are common among young children, many of whom are admitted to hospitals with acute neck swelling and clinical signs of inflammation.

The authors reviewed 210 files of pediatric patients (median age 4.5 years) admitted with an acute inflammatory neck mass between 2005 and 2008. All patients underwent diagnostic ultrasound and Doppler imaging of the neck, while contrast-enhanced CT was administered on 25 of the patients, with intravenous iodinated contrast material used in 23 of 25 cases.

Ultrasound only was used for 185 of the patients and was found to provide sufficient information to treat all but one patient (who had an abscess drained). In 164 patients, ultrasound demonstrated conditions that were managed conservatively with good outcomes.

Ultrasound demonstrated fluid collection in 17 patients in whom surgical abscess drainage was performed according to the sonographic findings. In one case of recurrent lymphadenitis, ultrasound demonstrated an inflammatory mass consisting of hypoechogenic enlarged lymph nodes and an excision biopsy was performed. In two patients, unsuccessful attempts to drain an abscess were made based on clinical indications, even though ultrasound didn’t reveal any fluid collections. In one case a collection of fluid wasn’t seen on a sonogram but a successful surgical drainage was performed at the point of fluctuation on palpitation.

Contrast-enhanced CT complemented the use of ultrasound in 25 patients. In 21 of the cases, CT didn’t provide additional information compared with sonographic findings, the researchers reported. In four children, CT provided additional information compared with ultrasound, revealing airways compromise in two and small fluid collections in two others. 

The authors concluded that ultrasound was highly accurate in determining—in most cases of acute inflammatory neck mass—that further evaluation with CT was unnecessary. They concluded that ultrasound should be the main technique for pediatric patients in these situations, and that CT should be reserved for patients with an aggravating clinical course and suspicion of a deep neck infection or compromised airways.