<p>Palpable soft-tissue masses in the pediatric head and neck are common and encompass a broad differential that includes congenital, infectious, inflammatory, and neoplastic processes. Owing to its ability to characterize lesion morphology, vascularity, and internal architecture without ionizing radiation, ultrasonography (US) remains the primary imaging modality for initial evaluation. This review focuses on pediatric head and neck masses, emphasizing practical US-based assessment and differential diagnosis. Entities discussed include common congenital lesions such as dermoid cysts, thyroglossal duct cysts, and branchial cleft anomalies, salivary gland abnormalities (including sialadenitis, sialolithiasis, ranulas, and salivary tumors), thymic lesions (such as ectopic thymus and thymic cysts), and thyroid abnormalities (including ectopic thyroid tissue, thyroid nodules, and thyroid malignancy).</p> Graphical Abstract <p></p>