Neck mass: Difference between revisions
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[[File:EB1911 - Tongue.png|thumb|Neck anatomy at the level of the tongue.]] | [[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.]] | [[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<ref>Pynnonen MA, et al. Clinical Practice Guideline: Evaluation of the Neck Mass in Adults. Otolaryngol Head Neck Surg. 2017 Sep;157(2_suppl):S1-S30. PMID 28891406</ref><ref>Chorath K, Rajasekaran K. Evaluation and Management of a Neck Mass. Med Clin North Am. 2021 Sep;105(5):827-837. PMID 34391536</ref> | ||
*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 | ||
Latest revision as of 10:53, 22 March 2026
Background
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- Common complaint seen in primary care medicine[1][2]
- 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:
- Pain
- Skin changes
- Stridor
- Hoarseness
- Fever
- URI symptoms
- Weight loss/night sweats
- 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
- Benign reactive lymph nodes
- Sialoadenitis
- Tenderness to affected salivary gland and pus at the duct orifice
- Parotid gland- stensen duct
- Submandibular gland- wharton duct
- Tenderness to affected salivary gland and pus at the duct orifice
Differential Diagnosis
Neck mass
Acute
- Reactive lymphadenopathy- most common
- Viral URI
- EBV
- CMV
- Strep/staph
- HIV
- Toxoplasmosis
- Bartonella henselae- kitten or flea exposure
- Tuberculous lymphadenitis (scrofula)
- Descending infections from oral cavity
- Sialoadenitis (can also be chronic)
- Trauma-related
- Hematoma
- Pseudoaneurysm or AV fistula
Subacute (weeks to months)
- Cancer
- Systemic diseases
Chronic
- Thyroid nodules or cancer
- Goiters
- Graves' disease
- Hashimoto thyroiditis
- Iodine deficiency
- Lithium use
- Toxic multinodular
- 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
- CT or ultrasound only if diagnosis is unclear
Management
- Reactive lymphadenopathy: see specific diagnosis
- Typically self resolving, supportive only except if related to bacterial disease
- Lymphadenitis
- Trial antibiotics with either first-generation cephalosporins, amoxicillin/clavulanate (Augmentin), or clindamycin
- Suppurative lymphadenitis/abscess
- Head and neck consultation may be necessary for drainage
- Sialoadenitis
- Sialogogues, gentle massage, express gland through duct
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./