Neck Masses

Indications for surgical resection of a neck mass include cancer or suspected cancer, hyperthyroidism not responsive to medical therapy, hyperparathyroidism, substernal extension, symptoms of pressure or choking, and cosmetic disfigurement.

Differential Diagnosis

• Inflammatory/infectious (enlarged lymph nodes are the most common neck mass)
  –Abscess
  –Acute lymphadenitis (bacterial, viral, fungal)
  –Tuberculous scrofula
  –Atypical mycobacterium
  –Mononucleosis
  –Cat-scratch disease
  –Sarcoidosis
  –HIV
• Congenital
  –Thyroglossal duct cyst
  –Branchial cleft cyst
  –Laryngocele
  –Cystic hygroma
  –Hemangioma
• Thyroid
  –Cancer (papillary, medullary, follicular/Hurthle cell, anaplastic)
  –Thyrotoxicosis (Graves’, toxic multinodular goiter, toxic thyroid nodule)
  –Thyroiditis (Hashimoto's, acute, subacute, Riedel's)
• Parathyroid
  –Hyperplasia
  –Adenoma
  –Carcinoma
• Primary tumor
  –Thyroid (see above)
  –Parathyroid (see above)
  –Salivary gland (parotid tumor most common)
  –Soft tissue tumor (lipoma, sebaceous cyst, inclusion cyst, carbuncle)
  –Carotid body tumor
  –Neurofibroma
  –Schwannoma
  –Angioma
  –Laryngeal tumor (chondroma)
  –Sarcoma
  –Skin cancer (melanoma, squamous cell carcinoma, basal cell carcinoma)
  –Lymphoma
  –Upper aerodigestive tract tumor
  • Metastasis

  Workup and Diagnosis

  • History should include age (congenital in young, cancer in elderly), recent growth (malignant lesions are fast-growing), localized symptoms (pain, dysphasia, hoarseness), radiation exposure (risk of thyroid cancer), social history (tobacco, alcohol), and family history (thyroid cancer)
  • Physical exam (including direct laryngoscopy) should evaluate for size, color, location and symmetry, consistency, and tenderness of the mass
  • Initial labs may include CBC, chemistries, BUN/creatinine, TSH, free T4, parathyroid hormone, ESR, calcium, phosphorus, and monospot test
  • Imaging
    –Chest X-ray to rule out lung metastasis
    –Ultrasound to determine whether mass is solid or cystic
    –CT/MRI
    –Angiography
    –Barium swallow
    –Radioactive iodine uptake scan
  • Fine needle aspiration and/or open biopsy may be necessary for definitive diagnosis

  Treatment

  • Antibiotics
  • Incision and drainage (abscess)
  • Antithyroid medications (PTU, methimazole)
  • Thyroid ablation with radioactive iodine (I_¹³¹ therapy)
  • Surgery
    –Parotidectomy
    –Parathyroidectomy
    –Thyroid lobectomy
    –Subtotal or total thyroidectomy
    –Neck dissection
    –Excisional biopsy
  • Chemotherapy
  • Radiation therapy
  • Immunotherapy

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

Other Book Chapters Related to Neck symptoms

Read excerpts from these other book chapters related to Neck symptoms:

Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Neck symptoms

• Back to symptom: Neck symptoms: Introduction (review 620 causes)
• Next Book Extract About Neck symptoms: Nuchal Rigidity (In A Page: Pediatric Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Neck symptoms

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

 » Next page: Nuchal Rigidity (In A Page: Pediatric Signs and Symptoms)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Nuchal Rigidity (In A Page: Pediatric Signs and Symptoms)
• Neck Masses (In A Page: Pediatric Signs and Symptoms)
• NECK PAIN (Differential Diagnosis in Primary Care)
• NUCHAL RIGIDITY (Differential Diagnosis in Primary Care)
• NECK MASS (Differential Diagnosis in Primary Care)

Tools & Services:

• Bookmark this page
• Take a survey relating to Neck symptoms
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City