Ask a doctor on the topic of Otorhinolaryngology

Suspicion of median neck cyst in a 4-year-old - surgery or not? Diagnosis unclear.

April 11, 2013 | 15,00 EUR | answered by Christian Welsch

Our 4-year-old son has a VA on a median neck cyst. An ultrasound at the ENT on Monday revealed that it was supposedly a lymph, but the entire neck including the thyroid should be examined (I don't know why). The pediatrician has now referred us to the Charite emergency department with suspicion of a median neck cyst. Now I have two different opinions. So far, no one has taken blood from our son, which I find strange. The pediatrician said that a neck cyst does not need to be operated on, as long as it does not cause any problems - but everywhere online it says that the cyst should be removed before it becomes infected. What is the right thing to do? Remove it or wait and what if it is actually a lymph or something else? How do I get a proper diagnosis? The lump is not inflamed - the child seems otherwise healthy (no infection). Six months ago, our son was bitten in the back of the head by a stranger's hunting dog (scars on the back of the head) - he also received antibiotics afterwards - the ENT rambled on about how that might be related.... The confused questioning describes roughly what is going on in my head right now... Thank you in advance for your advice. Thank you.

Christian Welsch

Dear inquirer,

One can differentiate a median neck cyst from a lymph node in an ultrasound with some experience and a good ultrasound device. Therefore, having an ultrasound in a university hospital is not wrong, as better equipment is usually available there.

A lymph node would be monitored, and one could also investigate whether there has been contact with pathogens as a trigger.

A neck cyst is usually operated on because it often becomes inflamed, and as people age (we are talking about the last third of life), there may be a low tendency for them to become malignant.

Based on what you describe, I would suggest waiting. If a cyst appears, I would eventually recommend having the child undergo surgery. Do you have any questions?

Regards, C. Welsch