Neck mass: Difference between revisions

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*Most commonly outpatient treatment either with trial antibiotics or supportive care only if inflammatory/infectious related
*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
*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
*Follow up important to ensure appropriate resolution and further need for advanced imaging or biopsy


==See Also==
==See Also==

Revision as of 04:23, 12 August 2016

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

Differential Diagnosis

  • Subacute (weeks to months)
    • Cancer
      • HPV-related squamous cell carcinoma
      • Upper aerodigestive tract squamous cell carcinoma
      • Metastatic disease
      • Lymphoma
      • Parotid tumors
    • Systemic diseases
  • 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

  • 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
      • Brachial 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
    • CT or US 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./>