Some Causes of Neck Mass
Cause | Suggestive Findings | Diagnostic Approach* |
|---|---|---|
Lymphadenopathy due to infectious disorders | ||
High-risk groups Generalized, painless adenopathy | Serologic testing for HIV | |
Multiple, nontender or moderately tender cervical nodes in an adolescent Usually pharyngitis and marked malaise | Serologic testing for Epstein-Barr virus | |
Oropharyngeal infection, viral or bacterial (most commonly pharyngitis or URI, sometimes a dental infection) | Frequently URI symptoms, sore throat, or toothache Acute, rubbery adenopathy, often tender Multiple enlarged nodes sometimes present in patients with viral URI | Usually clinical examination alone Sometimes throat culture |
Acute, isolated, tender adenopathy | Clinical examination alone | |
High-risk groups Matted, painless adenopathy, sometimes fluctuant | PPD or interferon-gamma release test Culture | |
Cancer† | ||
Local primary (eg, oropharyngeal, thyroid, salivary) Nodes from distant primary (eg, lymphomas, prostate, breast, colon, kidney) Nodes from local or regional primary (eg, lung, upper gastrointestinal) | For most common local primary cancers, usually in older patients, typically with significant tobacco use, alcohol consumption, or both May or may not have visible or palpable primary nodes (eg, in oropharynx) Cancerous masses likely to be firm or hard and fixed to underlying tissues rather than mobile Regional or distant metastases with or without local symptoms | Typically laryngoscopy, bronchoscopy, and esophagoscopy with biopsy of all suspect areas CT of the head, neck, and chest and possibly a thyroid scan |
Congenital disorders | ||
Branchial cleft cyst | Lateral mass, usually overlying the sternocleidomastoid muscle, often with a sinus or fistula | In children, ultrasonography In adults, CT |
Dermoid or sebaceous cyst | Rubbery and nontender (unless infected) | |
Thyroglossal duct cyst | Midline, nontender mass Usually manifests in childhood or adolescence but sometimes not until later | |
Other disorders | ||
Thyroid enlargement or one or more nodules | Thyroid function testing Thyroid scan Ultrasonography | |
Fever, usually thyroid tenderness and enlargement | ||
Submandibular salivary gland enlargement (eg, due to sialadenitis or stones) | Typically a painless mass just below the mandible laterally In patients with acute sialadenitis, a painful mass | CT and MRI Biopsy |
* Clinical examination is always done but is mentioned in this column only when that can be the sole means of diagnosis. | ||
† If cancer is a possible cause, patients are referred to an otolaryngologist for a head and neck examination. | ||
CT = computed tomography; PPD = purified protein derivative; URI = upper respiratory infection. | ||