Neck mass

Revisión del 10:25 22 mar 2026 de Danbot (discusión | contribs.) (Remove refs with incorrect PMIDs (verified against PubMed))

Background

Anatomy of the posterior pharynx.
Infrahyoid deep neck spaces
Neck anatomy at the level of the tongue.
Midline neck anatomy on lateral view.
  • 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:
  • Important to distinguish chronicity
  • 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: trismus, torticollis, stridor, drooling
    • Extrapulmonary form of mycobacterium tuberculosis (cervical adenopathy)
      • Multiple bilateral lymph nodes
      • Fixed, firm, non-tender, located typically in posterior triangle
    • Cystic masses
      • Soft, mobile, ballotable
      • Thyroglossal duct cyst: midline, adjacent to hyoid, rises with swallowing
      • Branchial cleft cyst: lateral, mandibular angle anterior to SCM
      • Dermoid cyst: submental triangle
    • Malignant lesions
      • Hard, non-tender, and possible immobile
  • Sialoadenitis
    • Tenderness to affected salivary gland and pus at the duct orifice
      • Parotid gland- stensen duct
      • Submandibular gland- wharton duct

Differential Diagnosis

Neck mass

Acute

Subacute (weeks to months)

Chronic

  • Thyroid nodules or cancer
  • Goiters
  • Congenital cysts
    • Branchial cleft cyst
    • Thyroglossal duct cyst- 2nd most common benign neck mass
    • Dermoid cyst
  • Carotid body tumor
  • Glomus jugulare or vagale tumor
  • Laryngocele
  • Lipoma/liposarcoma
  • Parathyroid cysts or cancer

Evaluation

Management

Disposition

  • Most commonly outpatient treatment either with trial antibiotics or supportive care only if inflammatory/infectious related
  • Inpatient admission reserved for severe infections, surgical drainage, or concerns for airway compromise
  • Follow up important to ensure appropriate resolution and further need for advanced imaging or biopsy

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./