This is a comprehensive article examining the modalities available for children presenting with suspected congenital neck lumps. Each modality is explained in turn, with pros and cons highlighted, but also in the context of the emergency patient and the elective. Diagnoses are made on the appearance of the lesion shown in each modality, in addition to the location within the neck. The author subdivides these locations into midline, lateral, posterior or the lesion’s relationship to the hyoid. For each of these locations the most likely differentials are discussed in terms of congenital possibilities in addition to acquired. The appearances of these diagnoses on each imaging modality are discussed with supporting cross-sectional images (although no ultrasound images unfortunately). For example, lateral masses described include first to fourth branchial cleft abnormalities but other differentials are discussed, including parotid cysts, atypical mycobacterial infection and lymphatic malformations for possible first cleft differentials. The differences in the presentations of these are discussed, both clinically and radiologically. For some reason the posterior neck differentials were not delineated and instead the article was completed by discussing cervical thymic cysts and teratomas. Annotating the images with arrows or labels would have been helpful for the non-radiologists among us and when it comes to radiographical articles, we can never have enough pictures!