II. Epidemiology
- Non-thyroid Neck Masses in Adults: 80% are neoplasms
- 80% malignant
- 80% of Salivary Gland Tumors in parotid
- 80% of Parotid Gland tumors benign
- 80% mixed tumors
III. Causes
IV. History
- Age over 45 is most important predictor of malignancy
- Size and duration of Neck Mass
- Symptom duration >2 weeks without signs of infectious cause
- Symptoms that help localize primary diagnosis
- Pharynx
- Larynx
- Hoarseness
- Voice quality change
- Otalgia (Referred via Cranial Nerves from Larynx)
- Habits with increased malignancy risk
- Miscellaneous symptoms
- Fever without obvious source
- Unexplained Weight Loss
- Night Sweats
- Neck Pain
- Cough
- Exposure history
- Tuberculosis exposure
- Foreign travel
- Occupation
- Sexual History
- Human Papilloma Virus is a risk for head and neck Squamous Cell Carcinoma (including cystic lesions)
- HIV Infection is associated with head and neck cancer (Kaposi's Sarcoma, Lymphoma)
- Head or neck Trauma
- Insect Bite
- Exposure to pets or farm animals
V. Examination
- See Mouth Exam
- See Submandibular Exam
VI. Imaging
- CT Neck with contrast
- First-line imaging for most persistent Neck Masses in Adults (present >3-4 weeks)
- Confirm patient can tolerate supine position for CT (esp. Hoarseness in Emergency Department)
- Large airway mass may obstruct airway in flat, supine position
- Contraindications to CT contrast
- See CT Intravenous Contrast for a complete list of contraindications
- Salivary Gland mass (contrast obscures Sialolith identification)
- Thyroid mass or metastatic Thyroid Cancer (iodinated contrast may stimulate growth)
-
Ultrasound
- First-line study for children with Neck Mass (reduces risk of CT-associated Radiation Exposure)
- Distinguishes cystic from solid lesions
- Evaluates Vascular Malformation flow rates
- Guides fine needle aspirate biopsy
- CT Angiography
- First line study for pulsatile Neck Mass
VII. Evaluation: Approach
- See Lymphadenopathy for other approach
-
Congenital Anomaly suspected
- Obtain CT neck
- Consider ENT referral
- Neoplasm suspected
- Obtain CT neck with contrast
- Fine-needle aspiration of mass
- Inflammatory or infectious process suspected
- Consider testing for cause (e.g. EBV, CMV, HIV)
- Consider empiric trial of broad-spectrum Antibiotic (if Bacterial cause is suspected)
- Only pursue trial Antibiotics if specific Bacterial Infection diagnosis suspected
- AAO-HNS does not recommend routine trial of Antibiotics otherwise
- Delays diagnosis of malignancy in >20% of cases
- No improvement at re-evaluation in 3-4 weeks
- Obtain Chest XRay
- Place PPD Tuberculin Skin Test (or Quantiferon-TB)
- Consider CT neck with contrast
- Consider fine needle aspirate of mass
VIII. References
- Broder (2021) Crit Dec Emerg Med 35(10): 10-1
- Fedok in Noble (2001) Primary Care Medicine, p. 1767-73
- Haynes (2015) Am Fam Physician 91(10): 698-706 [PubMed]
- McGuirt (1999) Med Clin North Am 83(1):219-34 [PubMed]
- Schwetschenau (2002) Am Fam Physician 66(5):831-8 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Finding (T033) |
| SnomedCT | 141808001, 164631007, 299703001 |
| Italian | Massa del collo |
| Japanese | 頚部腫瘤, ｹｲﾌﾞｼｭﾘｭｳ |
| English | neck cervical mass (___cm), neck mass, neck mass (physical finding), Mass of neck, mass of neck, neck lump, Growth on neck, Neck mass, Lump on neck, Mass of neck (finding), mass; neck, neck; mass, Neck Lump, Neck Mass, lump in the neck, Lump(s);neck |
| Czech | Rezistence na krku |
| Hungarian | Nyaki térfoglaló folyamat |
| Dutch | hals; massa, massa; hals, nekgezwel |
| Spanish | masa en el cuello (hallazgo), masa en el cuello, Masa en cuello |
| Portuguese | Massa no pescoço |
| French | Masse du cou |
| German | Raumforderung Hals |
