Neck Mass

Abstract

The evaluation of any neck mass begins with a careful, directed history focused on an appropriate differential diagnosis. Directed questions can narrow the diagnostic possibilities and focus subsequent investigations. For example, in younger patients, one might have an initial suspicion of congenital or inflammatory lesions, whereas in older adults, the primary concern is often neoplasia. The head and neck examination is challenging because much of the area to be examined is not easily seen. Patience and practice are necessary to master the special instruments and techniques of examination. Most neck masses in adults are abnormal and are often manifestations of underlying conditions that require treatment. In most cases, therefore, further diagnostic evaluation should be pursued. This review covers clinical evaluation, developing a differential diagnosis, investigative studies, and management of specific disorders associated with neck mass. Figures show cervical lymph nodes, a management algorithm for thyroid nodules, and the course of the thyroglossal duct from the foramen cecum to the pyramidal lobe of the thyroid gland. Tables list the etiology of neck mass, classification of cervical lymph nodes, and sonographic findings and size indications of biopsy of thyroid nodules. This review contains 4 figures, 9 tables, and 8 references. Key words: cervical adenopathy; cervical lymph nodes; congenital neck mass; enlarged lymph nodes; fine-needle aspiration; neck mass; thyroid disease; thyroid mass; thyroid nodule