The use of point of care ultrasound in the evaluation of pediatric soft tissue neck masses

Published:October 23, 2018DOI:



      Most soft tissue neck masses represent benign inflammatory or infectious processes; however, in some cases the diagnosis is not clear and a broader differential must be considered. The aim of this study was to compare point-of-care ultrasound (POCUS) to radiology department imaging (RDI) in the diagnosis of soft tissue neck masses.


      This prospective pilot study involved a convenience sample of patients ranging in age from 1 month to 18 years of age presenting to the Pediatric Emergency Department (PED) with a soft tissue neck mass. All children who presented to the PED with soft tissue neck mass at times when an investigator was in the department, and who were candidates for enrollment, underwent a POCUS. The managing pediatric emergency medicine (PEM) provider determined whether RDI was indicated. The results of the POCUS sonologist and radiologist were compared. The kappa statistic was used to analyze agreement with p < 0.05 denoting statistical significance.


      Twenty-seven patients were enrolled into the study. Twenty-two received radiology ultrasound (RUS), 3 patients received CT, and 2 patients received both RUS and CT. There was agreement between POCUS and RDI diagnoses in 21/27 cases (78%). Accordingly, overall concordance between POCUS and RDI diagnoses was good: the kappa statistic comparing diagnoses obtained by POCUS versus RDI was 0.69 (p < 0.001).


      This prospective pilot study describes the reliability of POCUS as an imaging modality in the management of patients with undifferentiated soft tissue neck masses. POCUS demonstrated good agreement with RDI as a bedside imaging tool in the evaluation of pediatric soft tissue neck masses.


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        • Gujar S.
        • Gandhi D.
        • Mukherji S.K.
        Pediatric head and neck masses.
        Top Magn Reson Imaging. 2004; 15: 95-101
        • Gosche J.R.
        • Vick L.
        Acute, subacute, and chronic cervical lymphadenitis in children.
        Semin Pediatr Surg. 2006; 15: 99-106
        • Kadom N.
        • Lee E.Y.
        Neck masses in children: current imaging guidelines and imaging findings.
        Semin Roentgenol. 2012; 47: 7-20
        • Rosenberg H.K.
        Sonography of pediatric neck masses.
        Ultrasound Q. 2009; 25: 111-127
        • Turkington J.R.
        • Paterson A.
        • Sweeney L.E.
        • Thornbury G.D.
        Neck masses in children.
        Br J Radiol. 2005; 78: 75-85
        • Marin J.R.
        • Dean A.J.
        • Bilker W.B.
        • Panebianco N.L.
        • Brown N.J.
        • Alpern E.R.
        Emergency ultrasound-assisted examination of skin and soft tissue infections in the pediatric emergency department.
        Acad Emerg Med. 2013; 20: 545-553
        • Sivitz A.B.
        • Lam S.H.
        • Ramirez-Schrempp D.
        • Valente J.H.
        • Nagdev A.D.
        Effect of bedside ultrasound on management of pediatric soft-tissue infection.
        J Emerg Med. 2010; 39: 637-643
        • Viera A.J.
        • Garrett J.M.
        Understanding interobserver agreement: the kappa statistic.
        Fam Med. 2005; 37: 360-363
        • Papadopouli E.
        • Michailidi E.
        • Papadopoulou E.
        • Paspalaki P.
        • Vlahakis I.
        • Kalmanti M.
        Cervical lymphadenopathy in childhood epidemiology and management.
        Pediatr Hematol Oncol. 2009; 26: 454-460
        • Friedman E.R.
        • John S.D.
        Imaging of pediatric neck masses.
        Radiol Clin North Am. 2011; 49 (v): 617-632
        • Tracy Jr., T.F.
        • Muratore C.S.
        Management of common head and neck masses.
        Semin Pediatr Surg. 2007; 16: 3-13
        • Ahuja A.T.
        • Ying M.
        Sonographic evaluation of cervical lymph nodes.
        AJR Am J Roentgenol. 2005; 184: 1691-1699
        • Riera A.
        • Hsiao A.L.
        • Langhan M.L.
        • Goodman T.R.
        • Chen L.
        Diagnosis of intussusception by physician novice sonographers in the emergency department.
        Ann Emerg Med. 2012; 60: 264-268
        • Sivitz A.B.
        • Cohen S.G.
        • Tejani C.
        Evaluation of acute appendicitis by pediatric emergency physician sonography.
        Ann Emerg Med. 2014; 64 ([e354]): 358-364
        • Marin J.R.
        • Lewiss R.E.
        • American Academy of Pediatrics
        • C. o. P. E. M.
        • Society for Academic Emergency, M.
        • American College of Emergency Physicians
        • et al.
        Point-of-care ultrasonography by pediatric emergency physicians. Policy statement.
        Ann Emerg Med. 2015; 65: 472-478
        • Howard Z.D.
        • Noble V.E.
        • Marill K.A.
        • Sajed D.
        • Rodrigues M.
        • Bertuzzi B.
        • et al.
        Bedside ultrasound maximizes patient satisfaction.
        J Emerg Med. 2014; 46: 46-53