May M
Pediatr Ann. 1976 Aug;5(8):517-35.
Neck masses in children most often represent benign lymphadenitis due to infection. The involved lymph nodes are usually small, shotty, diffusely distributed, and superficial. They may be tender and associated with an acute upper respiratory infection or with chronic infection of the tonsils and adenoids. Enlargement of the jugulodigastric node is most often associated with tonsillitis, and the spinal accessory group of nodes with adenoiditis. Acute viral diseases may be associated with lymphadenopathy; mononucleosis is the most striking example. The differential diagnosis must include deep neck-space abscesses, congenital cysts, and benign as well as malignant neoplasms. A diagnosis can be derived from a consideration of the history and physical findings, the age of the patient, and the location, size, and consistency of the mass. A careful otolaryngologic exam--including the nasopharynx, a chest radiograph, and appropriate blood studies--should be routine. When malignancy is suspected, a biopsy of the mass is indicated.
儿童颈部肿块最常见的原因是感染引起的良性淋巴结炎。受累淋巴结通常较小、呈小结节状、分布弥散且位于浅表。它们可能有压痛，并与急性上呼吸道感染或扁桃体及腺样体的慢性感染有关。颈二腹肌淋巴结肿大最常与扁桃体炎有关，副神经淋巴结组肿大则与腺样体炎有关。急性病毒性疾病可能伴有淋巴结病；传染性单核细胞增多症是最典型的例子。鉴别诊断必须包括颈部深部间隙脓肿、先天性囊肿以及良性和恶性肿瘤。可通过考虑病史、体格检查结果、患者年龄以及肿块的位置、大小和质地来做出诊断。常规应进行仔细的耳鼻喉科检查——包括鼻咽部、胸部X光片和适当的血液检查。当怀疑为恶性肿瘤时，应进行肿块活检。
