Midline and moving with tongue protrusion is a thyroglossal duct cyst; along the anterior border of sternocleidomastoid is a branchial cleft cyst; posterior triangle and trans-spatial is a lymphatic malformation — and most lumps are reactive nodes.
Orient first
- Reactive lymphadenopathy is by far the commonest cause.
- Suppurative nodes liquefy and need drainage when a fluid collection forms.
- Persistent, hard, supraclavicular or growing nodes without infection need biopsy (lymphoma).
Acquire the study
- High-frequency linear probe over the whole neck in transverse and longitudinal planes; colour Doppler; include the thyroid gland position.
The manoeuvre
- Position: midline (thyroglossal, dermoid), lateral anterior triangle (branchial), posterior triangle (lymphatic malformation), parotid.
- Content: anechoic vs internal echoes, septations, fluid-fluid levels (haemorrhage in lymphatic malformation).
- Nodes: short axis in mm, fatty hilum, cortical thickness, liquefaction with colour Doppler.
- Thyroglossal cyst: relation to the hyoid; confirm a normally sited thyroid gland.
- Vascularity on colour Doppler: haemangioma vs malformation.
What confirms it
- A characteristic position and content, or tissue for a solid persistent lesion.
What licenses you to exclude it
- Oval nodes with a fatty hilum and hilar vascularity in a child with infection are reactive; persistent abnormal nodes need follow-up or biopsy.
The classic misread
- Removing a thyroglossal cyst that contains the only thyroid tissue — confirm the gland.
- Calling a suppurative node an abscess needing drainage before it has liquefied.