Neck Lumps & Masses

The specific congenital and tumour entities behind a neck lump — see Presentation: Neck Lumps for the broader triage/differential approach.

Thyroglossal duct cyst

A congenital abnormality that may present at any age, but usually before adulthood — 60% diagnosed by age 20. Very common, often not clinically apparent (found in ~7% of adults on autopsy series). Caused by failure of closure of the thyroglossal duct — the most common midline congenital neck mass, arising anywhere from the base of the tongue to the thyroid, most commonly at the level of the hyoid bone.

Treatment: refer to a head and neck surgeon — conservative or surgical excision.

Branchial cleft cysts

Congenital, but cystic lesions (unlike sinuses/fistulae, which usually present in childhood with a visible skin punctum) classically present later, in the second decade of life or early adulthood. Usually a discrete, tender, erythematous lateral neck mass, associated with recurrent URTIs. Caused by failure of the pharyngeal clefts to involute — the most common lateral congenital neck mass (22% of congenital neck masses). May become secondarily infected.

Treatment: conservative if asymptomatic, or surgical excision.

Carotid body tumours

Carotid body tumour (carotid paraganglioma) — a benign neuroendocrine tumour. Demographics: age 40–60.

History and examination: pulsatile; painless. Moves laterally, but not vertically. Pulsatile on palpation; auscultation occasionally reveals a bruit.

Management: refer. Small or slow-growing tumours can be managed conservatively with active specialist monitoring. Surgical excision by ENT/vascular surgery if larger. Radiotherapy if not amenable to surgical excision.