Abstract

A practical approach to neck masses

Author(s): Stephen Rahem Ali, Lisa Pitkin

Undergraduate trainees need to be competent with assessing and managing basic neck masses; and teaching clinicians need to focus on strategies to increase the effectiveness of delivering the associated relevant clinical skills. Obtaining a good history and carrying out a thorough examination is the cornerstone for assessing a neck mass in order to reach the high standards expected during any consultation or medical assessment. This paper reviews how to systematically examine neck masses, provides practical tips and describes a framework for basic investigations. The most common adult neck masses are discussed, namely: cervical lymph node enlargement, thyroid lumps, neoplastic masses and lumps of salivary origin; as well as highlighting their key clinical features necessary for recognition during an Objective Structured Clinical Examination (OSCE) station – a common assessment tool in undergraduate medical curricula. Key points to elicit in the history are addressed, aiding discrimination between benign and malignant neck masses. Furthermore, this paper describes a schema that allows an understanding of anatomy and pathologies that arise from major anatomical structures to allow for an accurate diagnosis to be made. A methodological approach to structure which investigations are warranted, is also considered.