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
- 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
Differential Diagnosis
- Acute
- Reactive lymphadenopathy
- Viral URI
- EBV
- CMV
- Strep/staph
- HIV
- Toxoplasmosis
- Bartonella henselae
- Tuberculosis
- Descending infections from oral cavity
- Sialoadenitis (can also be chronic)
- Trauma-related
- Hematoma
- Pseudoaneurysm or AV fistula
- Reactive lymphadenopathy
- 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
- Cancer
- 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
Evaluation
- 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: truisms, torticollis, stridor, drooling
- Cystic masses
- Soft, mobile, ballotable
- Thyroglossal duct cyst: midline, adjacent to hyoid, rises with swallowing
- Brachial 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
- CT or US only if diagnosis is unclear
- Tenderness to affected salivary gland and pus at the duct orifice
Management
- Reactive lymphadenopathy: see specific diagnosis
- Viral URI- typically self resolving, supportive only
- Lymphadenitis
- Sialoadenitis
- Follow up < >
- Reactive lymphadenopathy: see specific diagnosis
Disposition
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./>