Neck lesions are common findings in pediatric patients and can be classified as congenital, vascular, inflammatory, or tumoral. They can be evaluated with ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging, either alone or in combination. US should be considered first for studying suspected congenital, vascular, and inflammatory lesions, although CT and MR imaging are best for demonstrating the extent of benign and malignant tumors and the presence or absence of bone erosion, vascular encasement, and airway compromise. MR imaging is also preferred for ruling out intracranial and intraspinal extension (eg, as occurs in rhabdomyosarcoma and neuroblastoma, respectively). In the authors' experience, thyroglossal duct cysts and lymphangioma are the most common congenital anomalies; jugular vein aneurysms are the most common vascular lesion; lymphadenitis is the most common inflammatory lesion; fibromatosis colli is the most common benign tumor or tumorlike condition; and lymphoma is the most common malignant neoplasm.