B.1. What preoperative studies should be obtained to evaluate the neck mass?
Answer:
Because cervical masses have a variable nature and the potential for airway compression, studies must be done preoperatively. Flexible neonatal bronchoscopy can define extrinsic compressive deformations of the airway. Ultrasound, CT, and MRI of the head and neck can define the nature of the cystic hygroma and elucidate the degree of airway compression. These cysts are known to invade the anterior mediastinum and can cause extrinsic distortion of the lower airway anywhere from the cricoid ring to the carina. If a neoplastic lesion is suspected, nuclear medicine studies can be utilized to gain functional assessment and staging. Once diagnostic imaging is obtained, interventional radiology can be consulted for minimally invasive procedures. Under sonographic guidance, cystic fluid can be aspirated to reduce the size of the mass and potentially relieve compressive symptoms. Rarely, there is invasion into the pericardium and displacement of the lung. If the mass is suprahyoid, radiologic studies can reveal the degree of laryngeal compression and retropharyngeal involvement, which are vital to know prior to intubation.
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