Base of tongue mass differential

[nacholibre]

So turns out my outpatient peds clinic is becoming quite the ENT experience. Today I was doing a well child exam and when the kid stuck out his tongue a huge smooth spherical mass popped up into view big enough to occlude the entire oropharynx (i.e. it was displacing the tonsils). The kid had no complaints of dysphagia or dyspnea/stridor, and was completely unaware that it even existed.

When I presented my attending gave me one of those "oh silly med 3" chuckles and said it was certainly the epiglottis and that this it is common to visualize the epiglottis on tongue protrusion.

So of course I was quite satisfied when she audibly "whoa'd" upon seeing the beast.

My question is what's on the differential for such a mass? And how in the world is it not causing some sort of symptom.

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[OtoHNS]

How old was the kid? What color was the mass?

From your description, lingual thyroid sounds like a likely possibility. Also, a large mucocele might present like that.

In general, for a pediatric tongue base lesion, your differential would include congenital lesions (lingual thyroid), benign masses (lingual tonsil hypertrophy, mucocele, other benign tumors), malignancy (rhabdomyosarcoma, lymphoma), infectious (papilloma), vascular (hemangioma, venous or lymphatic malformation). Probably some others that I'm forgetting as well...

 

[nacholibre]

the mass was a pale yellow, distinctly different color from the surrounding mucosa, it was remarkably smooth and appeared like it was cystic (i.e. thin walled).

 

[OtoHNS]

the mass was a pale yellow, distinctly different color from the surrounding mucosa, it was remarkably smooth and appeared like it was cystic (i.e. thin walled).

In that case, it sounds like a mucocele.

 

[resxn]

In that case, it sounds like a mucocele.

agree