Practice ABC of Ear, Nose and Throat, 6th Edition

Neck Swellings

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g1078 (Published 23 January 2014) Cite this as: BMJ 2014;348:bmj.g1078
  1. Nick Roland1,
  2. Patrick J. Bradley2
  1. 1University Hospital Aintree, Liverpool, UK
  2. 2Queen's Medical Centre Campus Nottingham University Hospitals Nottingham, UK


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Overview

  • Neck swellings are common findings that present in all age groups from many causes, ranging from congenital to acquired, from cysts, inflammatory, infective to neoplastic disease, encompassing any neck structures

  • In the community, the inflammatory lymph node is most common, whereas in hospital thyroid swelling or goitre is most frequently seen

  • It behoves all clinicians to understand the embryology and anatomy to aid with making the correct diagnosis thus allowing for appropriate management

  • There are more than 100 lymph nodes in each neck, and other organs or glands are singular!

  • Knowledge of patient's age, associated symptoms and anatomical location of the lump, is key to proceeding to treatment in General Practice, or is an indication for referral for further investigations, including imaging and surgery

  • Neck lumps in adults (over 40 years) should be considered malignant or at least have malignancy excluded by examination of the mucosal surfaces of the head and neck region, and a needle sample of lump be examined by a pathologist

Neck swellings are commonly encountered and present at all ages. The differential diagnosis of a neck mass is extensive. In the community inflammatory lymph nodes are most common, while in the hospital environment the thyroid swelling or goiter is most frequently seen. It therefore behoves all clinicians to understand the embryology and anatomy to aid with making the correct diagnosis and following an appropriate management algorithm.

Anatomy of the Normal Neck

The old surgical aphorism,

consider the anatomical structures and then the pathology that can arise from these

is never more …

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