Neck mass: Difference between revisions

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==Background==
==Background==
[[File:Gray1014.png|thumb|Anatomy of the posterior pharynx.]]
[[File:Infrahyoid deep neck spaces.png|thumb|Infrahyoid deep neck spaces]]
[[File:EB1911 - Tongue.png|thumb|Neck anatomy at the level of the tongue.]]
[[File:Human anatomy, including structure and development and practical considerations (1911) (14594049867).jpg|thumb|Midline neck anatomy on lateral view.]]
*Common complaint seen in primary care medicine
*Common complaint seen in primary care medicine
*Important to recognize acutely life threatening etiologies, treatable disease, and potential for malignancy  
*Important to recognize acutely life threatening etiologies, treatable disease, and potential for malignancy


==Clinical Features==
==Clinical Features==
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**Anterior and posterior cervical triangles divided by SCM
**Anterior and posterior cervical triangles divided by SCM
*Associated symptoms based on etiology:
*Associated symptoms based on etiology:
**Pain
**[[neck pain|Pain]]
**Skin changes
**Skin changes
**[[Stridor]]
**[[Stridor]]
**Hoarseness
**[[dysphonia|Hoarseness]]
**[[Fever]]
**[[Fever]]
**[[URI]] symptoms
**[[URI]] symptoms
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*Important to distinguish chronicity
*Important to distinguish chronicity


==Differential Diagnosis==
{{Neck mass DDX}}
==Evaluation==
*Assess for chronicity, associated symptoms, exposures (cats, undercook meat)
*Assess for chronicity, associated symptoms, exposures (cats, undercook meat)
*Physical Examination
*Physical Examination
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***Mobile, firm, and mildly tender
***Mobile, firm, and mildly tender
***Clinical diagnosis
***Clinical diagnosis
**Lymphadenitis/suppurative disease
**[[Lymphadenitis]]/suppurative disease
***Painful, erythema, possibly fluctuant  
***Painful, erythema, possibly fluctuant  
***Clinical diagnosis
***Clinical diagnosis
***CT imaging if concerns for deep space infection: trismus, torticollis, stridor, drooling
***CT imaging if concerns for deep space infection: trismus, [[torticollis]], [[stridor]], drooling
**Extrapulmonary form of Mycobacterium tuberculosis (cervical adenopathy)
**Extrapulmonary form of [[mycobacterium tuberculosis]] (cervical adenopathy)
***Multiple bilateral lymph nodes  
***Multiple bilateral lymph nodes  
***Fixed, firm, non-tender, located typically in posterior triangle  
***Fixed, firm, non-tender, located typically in posterior triangle  
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***Soft, mobile, ballotable
***Soft, mobile, ballotable
***Thyroglossal duct cyst: midline, adjacent to hyoid, rises with swallowing
***Thyroglossal duct cyst: midline, adjacent to hyoid, rises with swallowing
***Brachial cleft cyst: lateral, mandibular angle anterior to SCM
***[[Branchial cleft]] cyst: lateral, mandibular angle anterior to SCM
***Dermoid cyst: submental triangle
***Dermoid cyst: submental triangle
**Malignant lesions
**Malignant lesions
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***Parotid gland- stensen duct  
***Parotid gland- stensen duct  
***Submandibular gland- wharton duct
***Submandibular gland- wharton duct
**CT or US only if diagnosis is unclear
 
==Differential Diagnosis==
{{Neck mass DDX}}
 
==Evaluation==
*CT or [[ultrasound]] only if diagnosis is unclear


==Management==
==Management==
*Reactive lymphadenopathy: see specific diagnosis
*Reactive [[lymphadenopathy]]: see specific diagnosis
**Typically self resolving, supportive only except if related to bacterial disease
**Typically self resolving, supportive only except if related to bacterial disease
*Lymphadenitis
*[[Lymphadenitis]]
**Trial antibiotics with either first-generation cephalosporins, amoxicillin/clavulanate ([[Augmentin]]), or [[clindamycin]]
**Trial antibiotics with either first-generation [[cephalosporins]], amoxicillin/clavulanate ([[Augmentin]]), or [[clindamycin]]
*Suppurative lymphadenitis/abscess
*Suppurative [[lymphadenitis]]/[[abscess]]
**Head and neck consultation may be necessary for drainage
**Head and neck consultation may be necessary for drainage
*[[Sialoadenitis]]
*[[Sialoadenitis]]
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==References==
==References==
*<Haynes J, Arnold KR, Aguirre-Oskins C, and Chandra S. Evaluation of neck masses in adults. ''Am Fam Physician''. 2015 May 15;91(10):698-706./>
*Haynes J, Arnold KR, Aguirre-Oskins C, and Chandra S. Evaluation of neck masses in adults. ''Am Fam Physician''. 2015 May 15;91(10):698-706./
*<Kentab OY, Qureshi N. Chapter 118. Neck Masses in Children. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw-Hill; 2011. http://accessmedicine.mhmedical.com/content.aspx?bookid=348&Sectionid=40381590. Accessed August 11, 2016./>
*Kentab OY, Qureshi N. Chapter 118. Neck Masses in Children. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw-Hill; 2011. http://accessmedicine.mhmedical.com/content.aspx?bookid=348&Sectionid=40381590. Accessed August 11, 2016./


[[Category:ENT]]
[[Category:ENT]]
[[Category:Symptoms]]

Latest revision as of 22:12, 13 November 2024

Background

Anatomy of the posterior pharynx.
Infrahyoid deep neck spaces
Neck anatomy at the level of the tongue.
Midline neck anatomy on lateral view.
  • Common complaint seen in primary care medicine
  • Important to recognize acutely life threatening etiologies, treatable disease, and potential for malignancy

Clinical Features

  • Anatomy helpful in determining etiology
    • Anterior and posterior cervical triangles divided by SCM
  • Associated symptoms based on etiology:
  • Important to distinguish chronicity
  • Assess for chronicity, associated symptoms, exposures (cats, undercook meat)
  • Physical Examination
    • Benign reactive lymph nodes
      • Mobile, firm, and mildly tender
      • Clinical diagnosis
    • Lymphadenitis/suppurative disease
      • Painful, erythema, possibly fluctuant
      • Clinical diagnosis
      • CT imaging if concerns for deep space infection: trismus, torticollis, stridor, drooling
    • Extrapulmonary form of mycobacterium tuberculosis (cervical adenopathy)
      • Multiple bilateral lymph nodes
      • Fixed, firm, non-tender, located typically in posterior triangle
    • Cystic masses
      • Soft, mobile, ballotable
      • Thyroglossal duct cyst: midline, adjacent to hyoid, rises with swallowing
      • Branchial cleft cyst: lateral, mandibular angle anterior to SCM
      • Dermoid cyst: submental triangle
    • Malignant lesions
      • Hard, non-tender, and possible immobile
  • Sialoadenitis
    • Tenderness to affected salivary gland and pus at the duct orifice
      • Parotid gland- stensen duct
      • Submandibular gland- wharton duct

Differential Diagnosis

Neck mass

Acute

Subacute (weeks to months)

Chronic

  • Thyroid nodules or cancer
  • Goiters
  • Congenital cysts
    • Branchial cleft cyst
    • Thyroglossal duct cyst- 2nd most common benign neck mass
    • Dermoid cyst
  • Carotid body tumor
  • Glomus jugulare or vagale tumor
  • Laryngocele
  • Lipoma/liposarcoma
  • Parathyroid cysts or cancer

Evaluation

Management

Disposition

  • Most commonly outpatient treatment either with trial antibiotics or supportive care only if inflammatory/infectious related
  • Inpatient admission reserved for severe infections, surgical drainage, or concerns for airway compromise
  • Follow up important to ensure appropriate resolution and further need for advanced imaging or biopsy

See Also

External Links

References

  • Haynes J, Arnold KR, Aguirre-Oskins C, and Chandra S. Evaluation of neck masses in adults. Am Fam Physician. 2015 May 15;91(10):698-706./
  • Kentab OY, Qureshi N. Chapter 118. Neck Masses in Children. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw-Hill; 2011. http://accessmedicine.mhmedical.com/content.aspx?bookid=348&Sectionid=40381590. Accessed August 11, 2016./
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