Pediatric Neck Imaging Guidelines

Ultrasound is the required first-line study for most pediatric neck masses and thyroid problems; advanced imaging (CT, MRI, nuclear medicine) is covered only for documented active signs/symptoms, inconclusive ultrasound, or specific guideline-supported indications (eg, abscess, branchial pouch cysts, preoperative planning, parathyroid localization) and screening asymptomatic patients is excluded. Key requirements: recent (≤60 days) face‑to‑face history/physical and appropriate labs (eg, TSH for nodules, calcium/PTH for parathyroid), documentation of clinical findings or how repeat imaging will change management, a ≥4‑week conservative trial for uncomplicated lymphadenopathy (unless fever ≥100.4°F or concern for abscess), and consideration of gadolinium contraindications and anesthesia planning for MRI.

"Patients <18 years old should be imaged according to the Pediatric Neck Imaging Guidelines."