Neck masses in children can be inflammatory, congenital or neoplastic. When a congenital cyst becomes infected repeatedly, it may mimic inflammatory disease and the diagnosis may be challenging with ultrasound. An increasing incidence of infection with non-tuberculous mycobacterial organisms has been observed in recent decades in children with cervical lymphadenopathy. An ultrasound scan performed during the infectious phase of a mass can be misleading and can lead to an incorrect diagnostic hypothesis with the risk of erroneous medical and surgical therapies. We describe a case of a lateral neck epidermoid cyst mimicking and misdiagnosed as a tuberculous lymphadenopathy at ultrasound scan and treated with primary surgical excision. After surgery, a histological diagnosis of an epidermal cyst was made. There were no signs of recurrence during the 12-month follow-up period. A review of the literature and a proposed practice pathway for lateral cervical lymphadenopathy in children is also reported.

Keywords: child, epidermoid cyst, lymphadenopathy, neck, tuberculosis, ultrasound