Neck mass

Background

• Common complaint seen in primary care medicine
• Important to recognize acutely life threatening etiologies, treatable disease, and potential for malignancy

Clinical Features

• Enlarged neck lesions
  • Associated symptoms based on etiology may include:
    • Pain
    • Skin changes
    • Stridor
    • Hoarseness
    • Constitutional symptoms

Differential Diagnosis

• Acute
  • Reactive lymphadenopathy
    • Viral URI
    • EBV
    • CMV
    • Strep/staph
    • HIV
    • Toxoplasmosis
    • Bartonella
    • Tuberculosis
  • Sialadenitis (can also be chronic)
  • Trauma-related
    • Hematoma
    • Pseudoaneurysm or AV fistula

• Subacute (weeks to months)
  • Cancer
    • HPV-related squamous cell carcinoma
    • Upper aerodigestive tract squamous cell carcinoma
    • Metastatic disease
    • Lymphoma
    • Parotid tumors
  • Systemic diseases
    • Amyloidosis
    • Sarcoidosis
    • Sjögren syndrome

• Chronic
  • Thyroid nodules or cancer
  • Goiters
    • Graves disease
    • Hashimoto thyroiditis
    • Iodine deficiency
    • Lithium use
    • Toxic multinodular
  • Congenital cysts
    • Branchial cleft cyst
    • Thyroglossal duct cyst
    • Dermoid cyst
  • Carotid body tumor
  • Glomus jugulare or vagale tumor
  • Laryngocele
  • Lipoma/liposarcoma
  • Parathyroid cysts or cancer

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.>