113 - Differential Diagnosis of Neck Masses

Abstract

The understanding of the differential diagnosis of the neck mass is critical for the practicing otolaryngologist. Often, a neck mass is the only presenting sign for patients with head and neck cancer. Failure to achieve timely diagnosis can result in treatment delays that adversely affect patient prognosis. Understanding the differential between children and adults can avoid unnecessary testing and exposure for young children. A history and physical examination remains the cornerstone for differential diagnosis of the neck mass. Achieving diagnosis using minimally invasive techniques is also important. Often, open diagnostic procedures should be avoided in both adults and children and when necessary, only used in an oncologic manner. In this chapter, we review the diagnostic workup of the neck mass as well as highlight the differences between adults and children. Although we do not include a comprehensive list of diagnoses, our goal is to allow the clinician to develop a consistent thought process to work through the differential diagnosis. Throughout the chapter, we stress the importance in adults of keeping malignancy at the forefront of the clinician's mind to avoid diagnostic delays, particularly in the era of widespread HPV-related oropharyngeal cancer. Finally, this chapter should serve as a touchstone for a deeper understanding of the etiologies of the neck mass described in depth throughout the remaining textbook. When working through this chapter, we encourage the reader to reference the key etiologies described throughout the text to develop a well-rounded understanding of the various pathologies that present with a neck mass.