DIAGNOSIS CHECKLIST
for Neck swelling

Why: to determine if acute or chronic.

Why: to determine if swelling is focal, diffuse, midline or lateral and thus help establish diagnosis.

Why: multiple lumps are usually lymph nodes.

Why: An intermittent swelling suggests pulsion diverticulum, venous distention of congestive cardiac failure, a bronchial cyst, a stone of Wharton's duct (stone in the submandibular salivary gland duct) and aneurysms.

Why: e.g. cancer of the nasal cavity, pharynx, tongue, lips, mucous membrane (lining of the mouth), larynx and thyroid spread to neck lymph nodes.

Why: e.g. lithium and amiodarone may cause an enlarged goitre and hypothyroidism; most medications may cause enlarged lymph nodes. The most notable is dilantin, but the antibiotics, aspirin, iodides and certain antihypertensive drugs can cause enlarged lymph nodes also.

Why: e.g. neck swellings may result from intravenous neck vein drug abuse.

Why: e.g. cat scratch disease occurs between 7-14 days after a cat scratch or bite and features a small red papule at the site associated with localized lymph node enlargement; toxoplasmosis results from ingestion of foodstuffs contaminated by infected cat faeces.

Why: may help in determining the risk of syphilis and HIV if generalized lymph nodes enlargement.

Why: e.g. measles, rubella.

Why: e.g. neck, throat, ears, teeth, sinus - may help determine cause of neck swelling.

Why: should consider Grave's disease and subacute thyroiditis.

Why: may suggest congestive heart failure, tuberculosis, lung cancer. A thyroid swelling may also cause difficulty in breathing due to compression of the trachea.

Why: may suggest skin cancer with metastasis to the cervical lymph nodes.

Why: e.g. palpitations, increased heart rate, preference for cooler weather, intolerance of heat, increased appetite, weight loss, increased sweating, tremor, nervousness, irritability, diarrhea, lack of menstrual periods, frequent urination. May suggest Grave's disease, subacute thyroiditis (de Quervain's thyroiditis), toxic multinodular goitre or early Hashimoto's thyroiditis.

Why: e.g. symptoms of hyperthyroidism with a diffuse goitre (enlarged thyroid gland) and with protruding eyeballs.

Why: e.g. lethargy, weight gain, constipation, puffiness of face and eyes, hair loss, dry skin. Suggests Hashimoto's disease, drug induced hypothyroidism or dietary iodine deficiency.

Why: e.g. palpitations, shortness of breath, swelling of the ankles and lower legs. May also cause diffuse swelling of the neck due to venous distension.

Why: e.g. fever, sore throat, difficulty with swallowing due to pain, malaise, white pus spots on tonsils, enlarged neck lymph nodes.

Why: e.g. sore throat, fever, tiredness, poor appetite, aching muscles, skin rash, enlarged tonsils, enlarged neck lymph nodes.

Why: e.g. shortness of breath, cough, tiredness, joint pain, skin symptoms occur in 10% of cases and may include purple or brown plaques or nodules on face, nose, ears and neck in chronic sarcoidosis. Peripheral lymph node enlargement occurs in 5% of people.

Why: e.g. painless localized or widespread enlarged lymph nodes, sweating, generalized itch.

Why: e.g. painless (rubbery) enlarged lymph nodes especially in the neck or axilla, malaise, weakness, weight loss, fever, drenching night sweats, generalized itch, alcohol induced in any enlarged lymph nodes.

Why: e.g. painless ovoid swelling in the upper outer part of the neck. The swelling may become painful associated with an increase in size of the swelling.

Why: e.g. painless slow growing hard lump in the upper outer neck which pulsates.

Why: e.g. present at birth or within the first few years of life with a lobulated swelling at the base of the neck.

Why: e.g. long history of bad breath and recurrent sore throats before noticing the common presenting symptoms of regurgitation of undigested food. As the pouch grows it presses on the esophagus and causes difficulty with swallowing. The neck lump changes in size and often disappears.