Neck mass: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
* | *Anatomy helpful in determining etiology | ||
**Associated symptoms based on etiology | **Anterior and posterior cervical triangles divided by SCM | ||
** | *Associated symptoms based on etiology: | ||
**[[neck pain|Pain]] | |||
*** | **Skin changes | ||
*** | **[[Stridor]] | ||
*** | **[[dysphonia|Hoarseness]] | ||
**[[Fever]] | |||
**[[URI]] symptoms | |||
**Weight loss/night sweats | |||
*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== | ==Differential Diagnosis== | ||
{{Neck mass DDX}} | |||
==Evaluation== | ==Evaluation== | ||
*CT or [[ultrasound]] only if diagnosis is unclear | |||
==Management== | ==Management== | ||
*Reactive [[lymphadenopathy]]: see specific diagnosis | |||
**Typically self resolving, supportive only except if related to bacterial disease | |||
*[[Lymphadenitis]] | |||
**Trial antibiotics with either first-generation [[cephalosporins]], amoxicillin/clavulanate ([[Augmentin]]), or [[clindamycin]] | |||
*Suppurative [[lymphadenitis]]/[[abscess]] | |||
**Head and neck consultation may be necessary for drainage | |||
*[[Sialoadenitis]] | |||
**Sialogogues, gentle massage, express gland through duct | |||
==Disposition== | ==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== | ==See Also== | ||
*[[Sore throat]] | |||
==External Links== | ==External Links== | ||
==References== | ==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./> | |||
[[Category:ENT]] | |||
[[Category:Symptoms]] |
Latest revision as of 21:24, 30 September 2019
Background
- 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:
- Pain
- Skin changes
- Stridor
- Hoarseness
- Fever
- URI symptoms
- Weight loss/night sweats
- 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
- Benign reactive lymph nodes
- Sialoadenitis
- Tenderness to affected salivary gland and pus at the duct orifice
- Parotid gland- stensen duct
- Submandibular gland- wharton duct
- Tenderness to affected salivary gland and pus at the duct orifice
Differential Diagnosis
Neck mass
Acute
- Reactive lymphadenopathy- most common
- Viral URI
- EBV
- CMV
- Strep/staph
- HIV
- Toxoplasmosis
- Bartonella henselae- kitten or flea exposure
- Tuberculous lymphadenitis (scrofula)
- Descending infections from oral cavity
- Sialoadenitis (can also be chronic)
- Trauma-related
- Hematoma
- Pseudoaneurysm or AV fistula
Subacute (weeks to months)
- Cancer
- Systemic diseases
Chronic
- Thyroid nodules or cancer
- Goiters
- Graves' disease
- Hashimoto thyroiditis
- Iodine deficiency
- Lithium use
- Toxic multinodular
- 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
- CT or ultrasound only if diagnosis is unclear
Management
- Reactive lymphadenopathy: see specific diagnosis
- Typically self resolving, supportive only except if related to bacterial disease
- Lymphadenitis
- Trial antibiotics with either first-generation cephalosporins, amoxicillin/clavulanate (Augmentin), or clindamycin
- Suppurative lymphadenitis/abscess
- Head and neck consultation may be necessary for drainage
- Sialoadenitis
- Sialogogues, gentle massage, express gland through duct
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./>