Otolaryngology Book

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Neck Masses in AdultsAka: Neck Mass in the Adult, Adult Neck Mass

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  1. See Also
    1. Lymphadenopathy of the Head and Neck
  2. Epidemiology
    1. Non-Thyroid neck masses in adults: 80% are neoplasms
      1. 80% malignant
      2. 80% of Salivary Gland Tumors in parotid
        1. 80% of Parotid Gland tumors benign
        2. 80% mixed tumors
  3. Differential Diagnosis: Malignant Adult Neck Masses
    1. Metastatic Squamous Cell Carcinoma
    2. Thyroid Cancer
    3. Lymphoma
    4. Salivary Gland cancer
    5. Sarcoma
  4. Differential Diagnosis: Benign Neck Masses in Adults
    1. Lymphadenopathy or lymphadenitis
      1. See Lymphadenopathy of the Head and Neck
    2. Specific Infections
      1. Soft tissue neck abscess
      2. Tuberculosis or Atypical Mycobacterial infection
      3. Cat Scratch Disease
      4. Infectious Mononucleosis
    3. Vascular abnormalities
      1. Hemangioma
      2. Lymphangioma
    4. Soft tissue masses
      1. Paraganglioma
      2. Lipoma
      3. Neurofibroma
    5. Thyroid Goiter or other Thyroid mass
    6. Salivary Gland changes
      1. Parotid cyst
      2. Parotitis
      3. Sialolithiasis or Sialadenitis
      4. Sjogren's Syndrome
    7. Congenital anomaly
      1. Lateral neck
        1. Brachial cleft cyst
        2. Cystic Hygroma
        3. Dermoid
      2. Medial Neck
        1. Thyroglossal Duct Cyst
    8. Miscellaneous Conditions
      1. Sarcoidosis
      2. Kimura's Disease
        1. Ideopathic subcutaneous inflammation
      3. Castleman's Disease
        1. Benign lymphoproliferative condition of mediastinum
      4. Gout or Pseudogout (rarely involves neck)
  5. History
    1. Age over 45 is most important predictor of malignancy
    2. Size and duration of neck mass
    3. Symptoms that help localize primary diagnosis
      1. Pharynx
        1. Pharyngitis
        2. Dysphagia
        3. Otalgia
      2. Larynx
        1. Hoarseness
        2. Voice quality change
      3. Otalgia (Referred via Cranial Nerves from larynx)
        1. Cranial Nerve 9
        2. Cranial Nerve 10
    4. Habits with increased malignancy risk
      1. Tobacco abuse
      2. Alcohol Abuse
    5. Miscellaneous symptoms
      1. Fever
      2. Weight loss
      3. Night Sweats
      4. Neck pain
      5. Cough
    6. Exposure history
      1. Tuberculosis exposure
      2. Foreign travel
      3. Occupation
      4. Sexual history
      5. Head or neck trauma
      6. Insect Bite
      7. Exposure to pets or farm animals
        1. See Pet-Borne Parasitic Zoonoses
  6. Examination
    1. See Submandibular Exam
  7. Approach
    1. See Lymphadenopathy for other approach
    2. Congenital anomaly suspected
      1. Obtain CT neck
      2. Consider ENT referral
    3. Neoplasm suspected
      1. Obtain CT neck with contrast
      2. Fine-needle aspiration of mass
    4. Inflammatory or infectious process suspected
      1. Empiric trial of broad-spectrum antibiotic
      2. No improvement at re-evaluation in 2-4 weeks
        1. Obtain Chest XRay
        2. Place PPD Tuberculin Skin Test
        3. Consider CT neck with contrast
        4. Consider fine needle aspirate of mass
  8. References
    1. Fedok in Noble (2001) Primary Care Medicine, p. 1767-73
    2. McGuirt (1999) Med Clin North Am 83(1):219
    3. Schwetschenau (2002) Am Fam Physician 66(5):831

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