Pediatric Inflammatory Neck Mass

Abstract

The treatment of pediatric inflammatory neck masses depends upon the underlying etiology and may include both medical and surgical interventions. The most common causes of bacterial cervical lymphadenitis include Staphylococcus aureus (increasingly methicillin-resistant S. aureus), and Streptococcus pyogenes. A contrast-enhanced computed tomography (CT) scan can provide an accurate means of diagnosing whether an abscess is present which might need surgical drainage. Recent studies, however, have focused on the ability to diagnose abscesses using imaging studies that limit the patient exposure to radiation, including the use of ultrasound, magnetic resonance imaging (MRI) and low-voltage CT scanning. Recent database studies have demonstrated trends in the incidence and management of deep neck abscesses from 2000 to 2009. The incidence of retropharyngeal abscesses has increased while the incidence of peritonsillar abscesses, parapharyngeal abscesses or combined space deep neck infections has remained the same. Rates of incision and drainage for retropharyngeal abscesses have decreased, while for peritonsillar abscesses rates of incision and drainage have increased with a corresponding decrease in tonsillectomy rates. Fusobacterial infections have been associated with peritonsillar abscesses and deep neck space infections in association with Lemierre syndrome. These infections are treated with culture-directed antibiotics and surgical drainage when indicated and the prognosis is generally good when identified early. Kawasaki disease (KD) is a potential non-infectious/idiopathic cause of inflammatory pediatric neck mass. In addition to cervical lymphadenopathy, patients with Kawasaki disease may present with retropharyngeal cellulitits or abscess. It is critical that the patient with KD be identified within 10 days of illness onset so the child can be treated with intravenous immunoglobulin which has unequivocally been shown to decrease the incidence of potentially life-threatening cardiac aneurysms.