Neck Masses in Adults

Aka: Neck Masses in Adults, Neck Mass in the Adult, Adult Neck Mass, Neck Mass

1. See Also
   1. Causes of Neck Mass in Adults
   2. Lymphadenopathy of the Head and Neck
   3. Lymphadenopathy
   4. Neck Masses in Children
2. 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
3. Causes
   1. Causes of Neck Mass in Adults
4. 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
5. Examination
   1. See Submandibular Exam
6. 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
7. 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
8. References
   1. Fedok in Noble (2001) Primary Care Medicine, p. 1767-73
   2. Haynes (2015) Am Fam Physician 91(10): 698-706 [PubMed]
   3. McGuirt (1999) Med Clin North Am 83(1):219-34 [PubMed]
   4. Schwetschenau (2002) Am Fam Physician 66(5):831-8 [PubMed]