Ronda E. Alexander, Nazaneen N. Grant, and Andrew Blitzer

The finding of a mass in the upper aerodigestive tract is often discovered as a part of an investigation of a symptomatic complaint. These may include dysphonia, aphonia, dysphagia, dyspnea, hemoptysis, and odynophagia. This symptom directs the physician’s investigation to the site of the lesion. A mass may be congenital, infectious, inflammatory, neoplastic, or traumatic in nature, and there may be some overlap. Also, any lesion can cause bleeding if it is sufficiently traumatized. Historical points to consider include symptom duration, the presence of exacerbating or ameliorating factors, tobacco exposure, as well as recent travel and occupational risks. We divide the differential diagnosis of “mass” into groups according to the primary associated symptom; obviously some masses will cause multiple symptoms.

Primary Associated Symptom

Dysphagia

Dysphagia: To solids worse than liquids is indicative of a mass lesion within the upper digestive tract. The mass may be either intrinsic to the esophagus or an internal deformation caused by an external compression. Dysphagia may occur with or without odynophagia (painful swallowing).

Intrinsic mass

Foreign body granuloma: An irregularity overlying an ingested object; the mucosa may be intact or ulcerated.

Actinomycosis: May be associated with immumocompromise, although not always.

Epithelial malignancy (squamous cell carcinoma): May appear as an ulcerated elevation or as an irregularly elevated area of mucosa.

Glandular malignancy (ie, adenocarcinoma): Usually in the distal portion of the esophagus and associated with chronic changes related to gastroesophageal reflux

Sarcoma: Remember that striated muscle predominates in the proximal one third of the esophagus.

Neurofibromatosis type I: Plexiform neurofibroma may cause mechanical obstruction but it may also progress to pseudochalasia and liquid dysphagia.

Leiomyoma: A smooth, submucosal mass in the distal two thirds of the esophagus

Amyloid deposit: A smooth submucosal mass

Lymphatic malformation: Either infiltrative or externally compressive

External lesions impinging on the aerodigestive tract

Thoracic and mediastinal lymphadenopathy: Multiple etiologies

— Infectious, bacterial, or mycobacterial

— Neoplastic, usually from pulmonary primary neoplasm

— Autoimmune processes, most; commonly sarcoidosis

Thoracic vascular anomalies: Anomalous arterial or venous origin, aortic anomalies, aneurysms

Paraganglioma: Carotid body tumor, glomus vagale

Thyroid and parathyroid neoplasia: Benign or malignant

Ectopic thyroid: Often described in the tongue base, the mass effect of this tissue may impair lingual mobility and the passage of food bolus from the oral cavity to the pharynx.

Thyroglossal duct cyst and patent tract remnants: If high in the neck, these may compress/displace aspects of the pharynx.