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Neck Masses in Adults
Aka: Neck Masses in Adults, Neck Mass in the Adult, Adult Neck Mass, Neck Mass
- See Also
- Causes of Neck Mass in Adults
- Lymphadenopathy of the Head and Neck
- Lymphadenopathy
- Neck Masses in Children
- 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
- Causes
- Causes of Neck Mass in Adults
- History
- Age over 45 is most important predictor of malignancy
- Size and duration of Neck Mass
- Symptoms that help localize primary diagnosis
- Pharynx
- Pharyngitis
- Dysphagia
- Otalgia
- Larynx
- Hoarseness
- Voice quality change
- Otalgia (Referred via Cranial Nerves from Larynx)
- Cranial Nerve 9
- Cranial Nerve 10
- Habits with increased malignancy risk
- Tobacco Abuse
- Alcohol Abuse
- Miscellaneous symptoms
- Fever
- Weight loss
- Night Sweats
- Neck Pain
- Cough
- Exposure history
- Tuberculosis exposure
- Foreign travel
- Occupation
- Sexual History
- Head or neck Trauma
- Insect Bite
- Exposure to pets or farm animals
- See Pet-Borne Parasitic Zoonoses
- Examination
- See Submandibular Exam
- Imaging
- CT Neck with contrast
- First-line imaging for most persistent Neck Masses in Adults (present >3-4 weeks)
- 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
- 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)
- 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
- References
- 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]