6.2 Approach to Neck Masses
Key Features
A neck mass may be inflammatory, congenital, or neoplastic.
It may be anterior (midline), lateral, posterolateral, or supraclavicular.
The patient′s history should include age, duration, progression, pain, infection, smoking, prior cancer, exposure to tuberculosis, and animal exposure.
Neck masses are relatively common and may present at any age group. The differential diagnosis is broad, and both benign and malignant processes should be considered. A systematic approach is crucial to developing a rapid diagnosis and treatment plan.
Age is an important factor in evaluating a neck mass. The age groups include pediatric, young adult, and older adult (> 40 years). Each age group exhibits a certain relative frequency of disease occurrences, which can guide the diagnostician to further differential considerations. In general, neck masses in children are more commonly inflammatory or infectious. This is also true in young adults, although lymphoma is a consideration. In older adults, a neck mass should be considered neoplastic until proven otherwise.
The location of congenital neck masses is important; these lesions are often characterized by their location. The location of malignant neck masses, particularly if metastatic, may help identify the primary tumor ( Fig. 6.7 ).
Clinical
Signs and Symptoms
Depending on the cause, the neck mass may be painless (early neoplasm or congenital mass) or painful (infection or trauma). Depending on the etiology, associated symptoms may be those of an upper respiratory infection, toothache (infectious or inflammatory mass), or dysphagia, odynophagia, hoarseness, otalgia, hemoptysis, weight loss, night sweats, and fever (neoplasm).
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