A pediatric office gets all sorts of phone calls over the course of the day, and an important part of the staff's job is deciding which children need to be seen in the office and how urgently they need to be evaluated.
When a mother called to express concern about a lump on her 2-week-old's neck, our initial over-the-phone diagnosis was one of those small harmless glands commonly found along the neck's normal chain of lymph nodes. These little nodes are usually about the size of a pea, and while they should be checked during routine physical exams, they are not usually pathological and don't require parents to run in with their child for an emergency visit.
On further questioning, however, the patient's mom described what sounded like an unusually large neck mass that had apparently just popped up that day, so we brought mom and baby into the office for a check. My partner examined the little boy and was impressed with the size of the lump, which was about one inch in diameter and located within the sternocleidomastoid (SCM), the long strap of muscle found on either side of the neck. She referred mother and child to an ear-nose-throat specialist, who kindly agreed to see the little patient that same day.
The specialist felt that the mass was a relatively rare but, fortunately, benign fibrous lesion known variously as pseudotumor of infancy, sternocleidomastoid tumor of infancy, or fibromatosis colli. This diagnosis was confirmed the next day when an ultrasound of the boy's neck showed a hematoma, or collection of clotted blood, within the mid-to-lower portion of his SCM.
The baby's mother had experienced an easy, uneventful vaginal delivery without the need for forceps, and the child had no history of trauma to his neck, but the ear-nose-throat specialist did note that the child had mild torticollis (wry neck or twisted neck). Though pseudotumor is benign, it can be associated with such torticollis and can be accompanied by a noticeable head tilt and chin rotation.
Swiss researcher Dr. J. Meuwly and colleagues report several possible causes for these firm neonatal neck masses, including fibrosis caused by blockage of the venous system, by birth trauma, or by torticollis experienced by the fetus even before birth.
Experts at Miami Children's Hospital find that sternocleidomastoid tumor of infancy is generally not present at birth, but makes its appearance one to two weeks later as a hard, non-moveable swelling within the SCM itself. Once found, the mass must be further investigated to rule out the very rare possibility of a malignant neck lesion.
A benign sternocleidomastoid tumor typically enlarges over the first month, remains relatively stable for the next month, then gradually shrinks in size, and is usually gone by five to eight months of life. The recognized treatment for this neck muscle lesion is aggressive physical therapy. Therapists work to stretch the SCM, and emphasize the use of repositioning and "tummy time" to help treat existing torticollis or to prevent its development.
Surgery is rarely needed, and is generally reserved for the older, 6- to 24-month age group of little patients with severe torticollis who do not improve with physical therapy.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.