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Clear guidance for the assessment, diagnosis and management of paediatric neck lumps presenting to the Emergency Department.
Children with neck lumps.
Clinicians working in the Emergency Department.
Neck lumps are a common presentation to the Emergency Department. The differential is wide and includes inflammatory, congenital and neoplastic lesions. Establishing chronicity and the presence of infection is central to establishing the diagnosis. 80-90% of lesions represent benign conditions and the prevalence of palpable cervical lymphadenopathy occurs in 28-55% of normal children. Lymphoma is the most common neoplastic mass found. Detailed history and examination will facilitate preliminary diagnosis and guide further investigation, management and referral.
These patients will have a painful, tender often red swelling.
If the patient is well, observations within normal limits and there are no red flag features, treat with oral antibiotics and return to the Emergency ENT clinic, with instructions to return if there is a change in condition or concern.
If the patient is unwell contact ENT and arrange imaging and IV antibiotics
If the neck lump is the presenting complaint rather than a coincidental finding then advise parents to arrange follow up with GP. Treat source if indicated.
Document size, consistency and location and ensure follow up documented on discharge.
The type of swelling can often be determined by its location. Chronic neck swellings in the absence of red flag features can be referred to a routine ENT clinic. Refer patients for an outpatient US scan.
Thryoglossal duct Cyst
Posterior to Sternocleidomastoid muscle (SCM)
Anterior to SCM
Pre-auricular sinus / cyst
Multilocular Cystic Hygroma
FBC and film
Refer at the time of presentation to the appropriate specialty.
US is the first line and further imaging will be guided by ENT / Radiology. Attempt to arrange an US scan during attendance if 9 -5pm Monday to Friday. If out with this time, request an outpatient US on Trak.
The ED secretaries will arrange this using the ED notes, a referral letter is not required. Record on the front of the card that an ENT Out-patient clinic appointment is required and the time scale eg Emergency ENT clinic this week, appointment within 2-3 weeks. An appointment will be sent out to the family
Last reviewed: 01 December 2014
Next review: 13 December 2016
Author(s): Fiona Russell, David Lowe
Approved By: Clinical Effectiveness