Neck lumps
Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management
Definition
Neck lumps refer to palpable swellings in the neck that may arise from lymphatic, thyroid, salivary gland, congenital, or neoplastic causes.
Aetiology
- Inflammatory/reactive: lymphadenopathy due to infection (e.g., viral upper respiratory tract infections, tuberculosis, infectious mononucleosis).
- Neoplastic: lymphoma, metastatic carcinoma, thyroid malignancy.
- Congenital: thyroglossal cyst, branchial cyst, dermoid cyst.
- Salivary gland disorders: pleomorphic adenoma, salivary gland stones, mucoepidermoid carcinoma.
- Thyroid pathology: multinodular goitre, thyroid cyst, thyroid adenoma.
Pathophysiology
- Reactive lymphadenopathy occurs due to immune activation from infections or malignancy.
- Thyroid and salivary gland disorders cause structural abnormalities and localised swelling.
- Congenital cysts form due to failure of embryological remnants to regress.
- Neoplastic processes involve uncontrolled cellular proliferation leading to a mass effect.
Risk Factors
- Recent upper respiratory tract infections.
- Smoking and alcohol use (risk for head and neck malignancies).
- Family history of thyroid disease or lymphoma.
- Exposure to radiation.
- Chronic infections such as tuberculosis or HIV.
Signs and Symptoms
- Painless neck lump: suspicious for malignancy or congenital cyst.
- Tender lymphadenopathy: commonly associated with infection.
- Rapidly growing lump: raises concern for malignancy.
- Hoarseness or dysphagia: suggestive of thyroid or laryngeal involvement.
- Fluctuant mass: indicative of an abscess or cyst.
Investigations
- Ultrasound neck: first-line imaging to characterise the lump.
- Fine needle aspiration cytology (FNAC): differentiates benign from malignant lesions.
- CT/MRI scan: for deep-seated lesions or suspected malignancy.
- Thyroid function tests: if thyroid pathology is suspected.
- Serology: for infectious causes (EBV, HIV, tuberculosis screening).
- Excisional biopsy: for definitive histopathological diagnosis.
Management
1. Conservative Management:
- Observation for benign, reactive lymphadenopathy resolving with infection.
- Supportive care including analgesia and hydration.
2. Medical Management:
- Antibiotics for bacterial lymphadenitis or abscess.
- Antiviral therapy if associated with EBV or HIV.
3. Surgical Management:
- Excision: for persistent or suspicious lesions.
- Thyroidectomy: for thyroid malignancy or goitre with compressive symptoms.
- Neck dissection: for confirmed metastatic malignancy.
4. Referral:
- ENT specialist: for persistent, rapidly growing, or suspicious neck lumps.
- Oncology: if malignancy is confirmed or suspected.
- Endocrinology: for thyroid related neck lumps requiring further evaluation.
- Infectious diseases: if tuberculosis or other chronic infections are suspected.