Neck mass – long case / short case

History:

1. Site
2. Duration
3. Onset
4. Progress
5. Pain
6. Secondary changes – ulceration/ discharge
7. Aggravating factor
8. Relieving factor
9. Assoc symtoms: Dyspnea/ Dysphagia/ Trismus / Change of voice
10. Fever
11. URTI hx
12. LOA / LOW
13. H/o Trauma
14. Any other swelling elsewhere
15. Similar hx in the past

Examination:

Inspection:

1. Number
2. Site
3. Size
4. Shape
5. Surface
6. Edge
7. Skin changes – colour / ulcer / punctum/ discharge/ necrotic patch
8. Scar – transcervical / schobinger/ modified blair
9. Trachea deviation
10. Pulsatile
11. Movement on deglutition
12. Movement on protrusion of tongue

Palpation:

1. Local rise of temperature
2. Tenderness
3. Confirm inspector findings – number / site/ size/ shape/ surface
4. Consistency
5. Mobility
6. Fixity to overlying skin
7. Pulsation – expansile/ transmitted

Special tests on swelling:

– Transillumination test

Percussion

– Retrosternal extension

Auscultation

– Bruit: vascular

Examination of regional lymph nodes

  ~

Relative Prevalence of Neck Mass Etiologies

Type	Common	Uncommon	Rare
Acute	Cytomegalovirus infection Epstein-Barr virus infection Staphylococcal or streptococcal infection Toxoplasmosis Viral upper respiratory infection	Acute sialadenitis Arteriovenous fistula Bartonella henselae infection Hematoma Human immunodeficiency virus infection Mycobacterium tuberculosis infection Parotid lymphadenopathy Pseudoaneurysm	—
Subacute	Squamous cell carcinoma of the upper aerodigestive tract	Amyloidosis Lymphoma Metastatic cancer Parotid tumor Sarcoidosis Sjögren syndrome	Castleman disease Kikuchi disease Kimura disease Rosai-Dorfman disease
Chronic	Thyroid pathology	Branchial cleft cyst Carotid body tumor Glomus jugulare tumor Glomus vagale tumor Laryngocele Lipoma Thyroglossal duct cyst	Liposarcoma Parathyroid carcinoma

Reference:

1. Soo-Geun Wang. Differential Diagnosis and Treatment of Neck Masses. J Korean .Med Assoc. 2007 Jul;50(7):613-625.

2. James Haynes et all.  Evaluation of Neck Masses in AdultsAm Fam Physician. 2015 May 15;91(10):698-706.