Visual Diagnosis: 7-week-old Girl with a Neck Mass

Rachel Lieberman; Christine Scoby; Patrick Bacon; Mary Anne Jackson

doi:10.1542/pir.2016-0042

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Rachel Lieberman, MD*
Christine Scoby, DO*
Patrick Bacon, MD^†
Mary Anne Jackson, MD^‡

^*Department of Pediatrics,
^†Department of Radiology, Children's Mercy Hospital and Clinics, Kansas City, MO
^‡Division of Infectious Diseases, Children's Mercy Hospital and Clinics; Department of Pediatrics, University of Missouri–Kansas City School of Medicine, Kansas City, MO

AUTHOR DISCLOSURE
Drs Lieberman, Scoby, and Bacon have disclosed no financial relationships relevant to this article. Dr Jackson has disclosed that her institution receives research grants from the Vaccine and Treatment Evaluation Units, National Institutes of Health, and the New Vaccine Surveillance Network, Centers for Disease Control and Prevention. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A previously healthy 7-week-old infant born at term after an uncomplicated pregnancy, labor, and delivery presents after 2 weeks of an enlarging left cervical neck mass. The mass was initially visible only when the girl turned her head to the right. However, during the next 2 weeks, the mass doubled in size and became visible at all times. The infant continues to feed well, and has no history of fever, irritability, or ill symptoms.

The infant initially undergoes ultrasonography, which reveals a solid mass without fluid or calcifications. The mass is thought likely to be a lymph node. Given how quickly the mass has grown, the girl is admitted to the hospital for further evaluation and imaging.

Initial examination shows a well-grown, healthy-appearing infant with a rubbery, nontender, mobile left neck mass measuring 3 cm. The overlying swelling measures approximately 6 cm and starts at the left mandibular angle, with extension through the anterior cervical neck (Fig 1). There are no overlying skin findings, and the infant has full range of motion of her neck.

Figure 1.

Left mandibular angle swelling with bruising due to fine needle aspiration.

Magnetic resonance imaging (MRI) of the neck reveals a solid mass that abuts the posterior angle of the mandible, with no definite normal parotid tissue visualized. The mass measures 2.6 × 2.2 × 3.5 cm, with diffuse homogenous postcontrast enhancement and prominent flow voids coursing through it (Fig 2).

Figure 2.

Magnetic …