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
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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.

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