209 / 232
Fig 20.
Axial T1-weighted (A), coronal fat-suppressed T2-weighted (B), and axial contrast-enhanced fat-suppressed T1-weighted (C) MR
images of a child with a lymphoma. The images show a large mass in the right posterior cervical triangle. Multiple contiguous enlarged
lymph nodes are demonstrated and show trans-spatial extension (A, C) and caudal extension of involved lymph nodes in continuum (B).
The postcontrast images (C) reveal peripheral enhancement of the enlarged lymph nodes with central focal areas of absent enhancement
(necrosis).
Fig 21.
Axial fat-suppressed T2-weighted (A), sagittal fat-suppressed T2-weighted (B), and sagittal contrast-enhanced fat-suppressed T1-
weighted (C) MR images of a child with a rhabdomyosarcoma. The axial image (A) shows a large T2 hyperintense mass primary arising from
the oropharynx. The surrounding cervical spaces are predominantly displaced by the mass. The sagittal T2-weighted image (B) demonstrates
the extension into the nasopharynx and ethmoid sinus. Bony involvement is seen. On the contrast-enhanced image (C), relative homogenous
enhancement of the lesion with some areas of focal necrosis is seen.
(nasal cavity, paranasal sinuses, nasopharynx, pterygoid fossa,
middle ear), and nonparameningeal tumor site.
4,5,67
The ex-
tension of disease is evaluated preoperatively as well as post-
operatively and the staging system includes tumor size, nodal
status, site of primary tumor, and extent of residual disease. MR
imaging is the preferred imaging modality to assess the volume
of the lesion, the site of origin, and the relationship of the mass
to adjacent anatomical structures as well as potential intracra-
nial extension. The lesion demonstrates T2 hyperintense and
T1 isointense to slight hyperintense signal intensity compared
to skeletal muscle. Heterogeneity of the lesion can be due to
focal necrosis. There is moderate to intense enhancement on
postcontrast imaging sequences (Fig 21). On diffusion-weighted
MR imaging sequences, low intralesional ADC values correlate
with the malignant nature of the lesion. CT may be helpful to
evaluate bone involvement or destruction. The imaging stag-
ing requires chest CT, abdominal US, and bone scintigraphy to
search for distant metastatic disease.
1,5,67
Conclusion
Congenital and acquired neck masses in the pediatric popula-
tion comprise a variety of diverse conditions. By definition, con-
genital anomalies are present at birth. Lymphadenitis accounts
for the majority of acquired cervical masses in the pediatric age
group, and therefore the bulk of acquired neck masses are be-
nign lesions. Imaging plays a key role in establishing diagnosis
and is essential for precise localization and characterization of
the lesions. US allows an efficient assessment of neck masses in
young children and is the initial imaging technique of choice.
MRI provides better detailed information of the anatomic rela-
tionship and extension of these masses and can better depict the
nature of solid lesions. CT scans should be used conservatively
for selected, specific indications, in order to minimize ionizing
radiation exposures. By taking the patient’s age and clinical
history into consideration, as well as the involved anatomical
cervical region, the extent of the lesion, and the characteristic
imaging features, accurate definite diagnosis of neck masses can
be provided.
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