Neck Mass
last authored: August 2009, David LaPierre
Introduction
Differential Diagnosis
Acquired
- thyroid (approx 50%)
Infectious lymphadenitis
- Strep, other URI
- EBV and infectious mononucleosis
- cat scratch adenitis (Bartonella)
- mycobacterial adenitis
- actinomycosis
- HIV adenitis
- syphilis
- toxoplasmosis
Neoplastic lympadenopathy
- lymphoma
- metastatic carcinoma
salivary gland: The larger the gland, the less likely it is to be malignant
- most common is pleomorphic adenoma, arising from the parotid
Congenital or Developmental
- central: thyroglossal duct cyst (perihyoid)
- lateral: branchial cleft cyst
Normal anatomy
- parotid
- submandibular
- calcified carotid
History and Physical Exam
- history
- physical exam
History
Red Flags
- smoking, alcohol use
- HPV status
Physical Exam
Investigations
- biopsy
- lab investigations
- diagnostic imaging
Biopsy
Fine needle aspiration (FNA) is insufficient for lymphoma diagnosis. If this is suspected, lymph node excision is required.
Core biopsy
Open biopsy: excisional, incisional
Lab Investigations
Diagnostic Imaging
Management
Pathophysiology
Clinical Vignette 1
A person takes this treatment for this reason due to concerns re: condition
This happens.
How do you respond?
Clinical Vignette 2
Additional Resources
Merck Manual - approach to neck mass
Topic Development
created: DLP, Aug 09
authors: DLP, Aug 09
editors:
reviewers: