II. Epidemiology

  1. Non-thyroid Neck Masses in Adults: 80% are neoplasms
    1. 80% malignant
    2. 80% of Salivary Gland Tumors in parotid
      1. 80% of Parotid Gland tumors benign
      2. 80% mixed tumors

IV. History

  1. Age over 45 is most important predictor of malignancy
  2. Size and duration of Neck Mass
  3. Symptoms that help localize primary diagnosis
    1. Pharynx
      1. Pharyngitis
      2. Dysphagia
      3. Otalgia
    2. Larynx
      1. Hoarseness
      2. Voice quality change
    3. Otalgia (Referred via Cranial Nerves from Larynx)
      1. Cranial Nerve 9
      2. Cranial Nerve 10
  4. Habits with increased malignancy risk
    1. Tobacco Abuse
    2. Alcohol Abuse
  5. Miscellaneous symptoms
    1. Fever
    2. Weight loss
    3. Night Sweats
    4. Neck Pain
    5. Cough
  6. Exposure history
    1. Tuberculosis exposure
    2. Foreign travel
    3. Occupation
    4. Sexual History
    5. Head or neck Trauma
    6. Insect Bite
    7. Exposure to pets or farm animals
      1. See Pet-Borne Parasitic Zoonoses

V. Examination

VI. Imaging

  1. CT Neck with contrast
    1. First-line imaging for most persistent Neck Masses in Adults (present >3-4 weeks)
    2. Contraindications to CT contrast
      1. See CT Intravenous Contrast for a complete list of contraindications
      2. Salivary Gland mass (contrast obscures Sialolith identification)
      3. Thyroid mass or metastatic Thyroid Cancer (iodinated contrast may stimulate growth)
  2. Ultrasound
    1. First-line study for children with Neck Mass (reduces risk of CT-associated Radiation Exposure)
    2. Distinguishes cystic from solid lesions
    3. Evaluates vascular malformation flow rates
    4. Guides fine needle aspirate biopsy
  3. CT Angiography
    1. First line study for pulsatile Neck Mass

VII. Evaluation: Approach

  1. See Lymphadenopathy for other approach
  2. Congenital Anomaly suspected
    1. Obtain CT neck
    2. Consider ENT referral
  3. Neoplasm suspected
    1. Obtain CT neck with contrast
    2. Fine-needle aspiration of mass
  4. Inflammatory or infectious process suspected
    1. Consider testing for cause (e.g. EBV, CMV, HIV)
    2. Consider empiric trial of broad-spectrum antibiotic (if Bacterial cause is suspected)
    3. No improvement at re-evaluation in 3-4 weeks
      1. Obtain Chest XRay
      2. Place PPD Tuberculin Skin Test (or Quantiferon-TB)
      3. Consider CT neck with contrast
      4. Consider fine needle aspirate of mass

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Related Studies

Ontology: Mass of neck (C0149736)

Concepts Finding (T033)
SnomedCT 141808001, 164631007, 299703001
Italian Massa del collo
Japanese 頚部腫瘤, ケイブシュリュウ
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