Pitfalls & Challenges

Recent evidence emphasizes the reliability and safety of PoCUS  in assessing neck swelling in children. However, the majority of current evidence derives from the radiology literature and further research is needed to evaluate the effectiveness and usefulness of PoCUS for these applications.

Many conditions leading to neck swelling cause local tenderness. This discomfort may make examination difficult. Pain can be managed by administering systemic analgesia and/or applying a generous layer of ultrasound gel to minimize direct probe contact and reduce the pressure needed to obtain images.

While ultrasound is effective in evaluating relatively superficial pathologies, it is not as dependable for assessing deeper neck structures and spaces, making pathologies, such retropharyngeal infection/abscess more challenging to assess. In these instances, modalities such as CT or MRI are superior. (9,10)

When assessing findings in the pediatric neck, it is also important to consider a broad differential diagnosis, as not all abnormalities represent reactive nodes and premature diagnostic closure on this common condition is a risk. Other conditions may resemble lymph nodes, including benign or malignant solid tumors, congenital cysts, and abscesses.