Neck swellings

• swellings in the neck (1)
  • are frequently encountered among both children and adults
  • a detailed history and a thorough physical examination is necessary
    • key points in the history and examination are
      • age
      • site
      • size
      • duration of the mass
  • causes of neck swellings seen in different age groups include (1)
    • children - congenital masses, like branchial anomalies (branchial cleft cyst or sinus) and thyroglossal duct cysts (2)
    • young adults- inflammatory and infectious neck masses e.g. cervical adenitis
    • older adults - benign and malignant neoplasms (1)
  • congenital anomalies, which are more common in children, should also be considered in the differential diagnosis of neck masses in adults (1)
  • only swellings which are deep to the deep cervical fascia are specific to the neck
    • the deep cervical fascia envelopes the sternocleidomastoid muscles
    • tensing of these muscles will tend to obscure deeper masses
  • techniques for evaluating these masses include (1)
    • fine-needle aspiration and biopsy (cytology)
    • contrast-enhanced computed tomographic scanning

References:

1. Pynnonen M et al. Clinical Practice Guideline: Evaluation of the Neck Mass in Adults. Practice Guideline. Otolaryngol Head Neck Surg. 2017 Sep;157(2_suppl):S1-S30.
2. Meier J. Evaluation and management of neck masses in children. Am Fam Physician. 2014 Mar 1;89(5):353-8.