Picture quiz. A midline neck lump in a child.

TL;DR: An 11 year old girl presented with a six month history of a swelling in the midline of her neck, overlying her hyoid bone, with a bright red exophytic lesion with a diameter of 7 mm, which moved upwards when she protruded her tongue.

Abstract: An 11 year old girl presented with a six month history of a swelling in the midline of her neck, overlying her hyoid bone. Three weeks previously, the skin overlying the swelling had broken down and the area had bled and been painful ever since. She was fit and well and denied trauma to the area. She was taking no drugs and reported no allergies. Her maternal grandmother had a multinodular goitre removed when she was 30 years of age. Examination showed a bright red exophytic lesion with a diameter of 7 mm in the midline of her neck (figure⇓). The lump moved upwards when she protruded her tongue. Intraoral examination was grossly normal. There was no palpable lymphadenopathy. ### 1 What are the differential diagnoses for this lesion? #### Short answer The main causes of a midline swelling of the neck in a child are congenital abnormalities (thyroglossal cysts, ranulas, ectopic thyroid cysts, dermoid cysts), infection (abscess), trauma (pyogenic granulomas), cancer (lymphoma, lymphadenopathy), and vascular abnormalities (haemangioma, lymphangioma). #### Long answer Thyroglossal cysts account for about 75% of congenital midline swellings in childhood,1 2 and they are the most common abnormality of the midline neck seen in children.2 3 4 Most present by age 5 years …