Neck mass


  • Common complaint seen in primary care medicine
  • Important to recognize acutely life threatening etiologies, treatable disease, and potential for malignancy

Clinical Features

  • Anatomy helpful in determining etiology
    • Anterior and posterior cervical triangles divided by SCM
  • Associated symptoms based on etiology:
  • Important to distinguish chronicity
  • Assess for chronicity, associated symptoms, exposures (cats, undercook meat)
  • Physical Examination
    • Benign reactive lymph nodes
      • Mobile, firm, and mildly tender
      • Clinical diagnosis
    • Lymphadenitis/suppurative disease
      • Painful, erythema, possibly fluctuant
      • Clinical diagnosis
      • CT imaging if concerns for deep space infection: trismus, torticollis, stridor, drooling
    • Extrapulmonary form of mycobacterium tuberculosis (cervical adenopathy)
      • Multiple bilateral lymph nodes
      • Fixed, firm, non-tender, located typically in posterior triangle
    • Cystic masses
      • Soft, mobile, ballotable
      • Thyroglossal duct cyst: midline, adjacent to hyoid, rises with swallowing
      • Branchial cleft cyst: lateral, mandibular angle anterior to SCM
      • Dermoid cyst: submental triangle
    • Malignant lesions
      • Hard, non-tender, and possible immobile
  • Sialoadenitis
    • Tenderness to affected salivary gland and pus at the duct orifice
      • Parotid gland- stensen duct
      • Submandibular gland- wharton duct

Differential Diagnosis

Neck mass


Subacute (weeks to months)


  • Thyroid nodules or cancer
  • Goiters
  • Congenital cysts
    • Branchial cleft cyst
    • Thyroglossal duct cyst- 2nd most common benign neck mass
    • Dermoid cyst
  • Carotid body tumor
  • Glomus jugulare or vagale tumor
  • Laryngocele
  • Lipoma/liposarcoma
  • Parathyroid cysts or cancer




  • Most commonly outpatient treatment either with trial antibiotics or supportive care only if inflammatory/infectious related
  • Inpatient admission reserved for severe infections, surgical drainage, or concerns for airway compromise
  • Follow up important to ensure appropriate resolution and further need for advanced imaging or biopsy

See Also

External Links


  • <Haynes J, Arnold KR, Aguirre-Oskins C, and Chandra S. Evaluation of neck masses in adults. Am Fam Physician. 2015 May 15;91(10):698-706./>
  • <Kentab OY, Qureshi N. Chapter 118. Neck Masses in Children. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw-Hill; 2011. Accessed August 11, 2016./>