Differential Diagnoses
Inflammatory lymphadenopathy
- Most common cause of neck swellings
- Acute, multiple, small tender and mobile lymph nodes bilaterally which may be red and warm
- There may be a history of infection
- Usually subsides after 3-6 weeks following infection
Malignant lymphadenopathy
- Rubbery and painless lymphadenopathy
- There may be associated hepatomegaly and/or splenomegaly
- Systemic symptoms e.g. fever/night sweats/weight loss may be present
Lipoma
- Most common benign neck tumour
- Slow-growing and non-invasive
- Usually painless, soft, mobile and discrete subcutaneous mass
- Can occur anywhere on the body
Thyroid goitre
- May be nodular or diffuse
- They all move upwards with swallowing
Salivary gland tumours
- More common in older people
- 80% are benign and arise in the parotid gland
- Well-defined, painless, slow-growing and mobile
Sialolithiasis (salivary gland stones)
- Most commonly affect the submandibular gland
- Swelling and tenderness are worse with eating due to increased saliva production
Salivary gland infection (sialadenitis)
- Usually due to Staphylococcus aureus or mumps
- Usually affects the parotid gland
- Mumps usually have bilateral parotid swelling, otalgia, trismus, and sometimes orchitis
- Rapid-onset pain and swelling with localised tenderness
- Compression of the duct may cause purulent discharge to enter the oral cavity
Thyroglossal cyst
- Most common congenital cyst
- Usually seen in young children
- May grow rapidly after an upper respiratory tract infection
- Usually well-defined, midline, non-tender cystic lump that moves upward when the person swallows or sticks out their tongue
Branchial cyst
- Usually seen in children/adolescents
- Painless, slow-growing, smooth, and fluctuant swelling in the lateral neck
- Usually at the junction of the upper 1/3 and lower 2/3 of the anterior sternocleidomastoid muscle border
Cystic hygroma (lymphangioma)
- Poorly-defined fluctuant mass that transilluminates
- Usually seen in the posterior triangle of the neck and present from birth
Carotid aneurysm
- Pulsatile lateral neck mass
- May follow trauma/underlying vascular disease or vasculitis or surgery
