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Causes of Neck Mass in Adults

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Causes of Neck Mass in Adults, Neck Mass Causes in Adults

  • See Also
  1. Neck Masses in Adults
  2. Lymphadenopathy of the Head and Neck
  3. Lymphadenopathy
  4. Neck Masses in Children
  • Causes
  • Acute (days to weeks)
  1. Common
    1. Most causes are reactive Lymphadenopathy
    2. Viral Infection
      1. Epstein-Barr Virus (EBV)
      2. Cytomegalovirus (CMV)
      3. Upper Respiratory Infection
    3. Bacterial Infection
      1. Staphylococcal or Streptococcal infection of the head or neck
    4. Parasitic Infection
      1. Toxoplasmosis
  2. Uncommon
    1. Infection
      1. Acute Sialadenitis (or Sialolithiasis)
      2. Bartonella Henselae (Cat Scratch Disease)
      3. Acute HIV Infection
      4. Actinomyces
      5. Mycobacterium tuberculosis
        1. Diffuse bilateral fixed Lymph Nodes
      6. Bacterial Lymphadenitis (may effect any Lymph Node, but submandibular is most common)
        1. Staphylococcal Lymphadenitis (esp. in preschool children, and unilateral in 90% of cases)
        2. Streptococcal Lymphadenitis
    2. Trauma or vascular cause
      1. Hematoma
      2. Pseudoaneurysm or Arteriovenous Fistula (pulsatile mass)
  • Causes
  • Subacute (weeks to months)
  1. Common: Head and Neck Malignancy
    1. HPV related oropharyngeal Squamous Cell Carcinoma accounts for 70% of new head and neck cancers
    2. May present with matted firm, fixed Lymph Nodes
    3. May be associated with non-healing ulcers, Hoarseness, Hemoptysis, Dysarthria, Dysphagia
    4. Distribution
      1. Squamous Cell Carcinoma of the Oropharynx
      2. Squamous Cell Carcinoma of the Tongue
      3. Squamous Cell Carcinoma of the Larynx
  2. Uncommon
    1. Lymphoma (Hodgkin, non-hodgkin)
    2. Metastatic cancer
    3. Salivary Gland Tumor (e.g. Parotid Tumor)
    4. Sarcoidosis
      1. Painless Lymphadenopathy (cervical, axillary, inguinal)
    5. Sjogren Syndrome
      1. Bilateral Parotid Gland enlargement
    6. Amyloidosis
      1. Painless Generalized Lymphadenopathy
      2. May be associated with other systemic disease (e.g. CHF, Nephrotic Syndrome, Neuropathy)
  3. Rare
    1. Castleman Disease (angiofollicular lymphoproliferative disease)
      1. Benign lymphoproliferative condition of mediastinum presenting with a single inflamed Lymph Node
    2. Kikuchi Disease (histiocytic necrotizing Lymphadenitis)
      1. Self limited (3 month course) of fever, posterior Lymphadenopathy and Leukopenia
    3. Kimura Disease
      1. Non-tender, idiopathic Subcutaneous Mass associated with Eosinophilia; endemic in Asia
    4. Rosai-Dorfman Disease
      1. Matted Lymphadenopathy with occasional fever in otherwise healthy adults
  • Causes
  • Chronic (months to years)
  1. Common
    1. Thyroid mass (Thyroid Nodule, Graves Disease, Goiter, Hashimoto Thyroiditis, Lithium)
  2. Uncommon (in adults)
    1. Lipoma
    2. Laryngocele
      1. Due to recurrent forceful nose blowing, coughing or wind instrument use
      2. Mass lateral to the Thyroid cartilage
      3. Increases in size with increased laryngeal pressure
    3. Congenital Anomaly
      1. Branchial Cleft Cyst
        1. Upper Neck Mass, anterior to sternocleidomastoid Muscle
        2. May enlarge with Upper Respiratory Infections, or present with acute inflammation
        3. Typically diagnosed in childhood
      2. Thyroglossal Duct Cyst
        1. Midline Neck Mass near Hyoid Bone that elevates with Swallowing or Tongue protrusion
      3. Dermoid Cyst
        1. Congenital, benign, slow-growing soft, doughy cyst in midline submental neck (children, young adults)
    4. Parasympathetic tumors or paragangliomas of the neck (Flushing, Palpitations, Hypertension with local affects)
      1. Carotid body tumor
      2. Glomus jugulare tumor
      3. Glomus vagale tumor
  3. Rare
    1. Parathyroid cancer or Parathyroid cyst
    2. Liposarcoma
      1. Enlarging painless Neck Mass
      2. May be difficult to differentiate from the more typical Lipoma
  1. Metastatic Squamous Cell Carcinoma
  2. Thyroid Cancer
  3. Lymphoma
  4. Salivary Gland cancer
  5. Sarcoma
  1. Lymphadenopathy or Lymphadenitis
    1. See Lymphadenopathy of the Head and Neck
  2. Specific Infections
    1. Soft tissue neck abscess
    2. Tuberculosis or Atypical Mycobacterial infection
    3. Cat Scratch Disease
    4. Infectious Mononucleosis
  3. Vascular abnormalities
    1. Hemangioma
    2. Lymphangioma
  4. Soft Tissue Masses
    1. Paraganglioma
    2. Lipoma
    3. Neurofibroma
  5. Thyroid Goiter or other Thyroid mass
  6. Salivary Gland changes
    1. Parotid cyst
    2. Parotitis
    3. Sialolithiasis or Sialadenitis
    4. Sjogren Syndrome
  7. Congenital Anomaly
    1. Lateral neck
      1. Brachial cleft cyst
      2. Cystic Hygroma
      3. Dermoid
    2. Medial Neck
      1. Thyroglossal Duct Cyst
  8. Miscellaneous Conditions
    1. Sarcoidosis
    2. Gout or Pseudogout (rarely involves neck)
    3. Castleman Disease (angiofollicular lymphoproliferative disease)
      1. Benign lymphoproliferative condition of mediastinum presenting with a single inflamed Lymph Node
    4. Kikuchi Disease (histiocytic necrotizing Lymphadenitis)
      1. Self limited (3 month course) of fever, posterior Lymphadenopathy and Leukopenia
    5. Kimura Disease
      1. Non-tender, idiopathic Subcutaneous Mass associated with Eosinophilia; endemic in Asia
    6. Rosai-Dorfman Disease
      1. Matted Lymphadenopathy with occasional fever in otherwise healthy adults
  • References
  1. Fedok in Noble (2001) Primary Care Medicine, p. 1767-73
  2. Haynes (2015) Am Fam Physician 91(10): 698-706 [PubMed]
  3. McGuirt (1999) Med Clin North Am 83(1):219-34 [PubMed]
  4. Schwetschenau (2002) Am Fam Physician 66(5):831-8 [PubMed]