Definition and Overview
A swelling in the neck, which can be due to neck lumps or masses, are caused by a wide range of possible conditions, most of which are not serious threats to health. There are times, however, that a neck lump is a sign of a more serious problem, such as a malignant mass or an infection. Thus, any abnormal growth or swelling in the neck area should be evaluated by a medical professional, especially if it does not seem to have an obvious cause.
Swelling in the neck may present in many forms. Some are hard, easy-to-find lumps, while others are soft and may seem to move around when touched. Some are located right on the skin, just like acne or sebaceous cysts, while some form from within the neck. The location of the mass is an important clue as to what the lump really is, but doctors usually perform several tests to determine the real cause of swelling since the neck holds a lot of key tissues and muscles, many of which play important roles in the body.
Cause of Condition
Swelling in the neck is often the result of conditions that affect its many structures such as:
- The windpipe, also known as the trachea
- The voice box, also known as the larynx
- The thyroid gland, a butterfly-shaped organ located just below the Adam’s apple
- The parathyroid gland, the four smaller glands near the thyroid gland
- The salivary glands, or the parotids
- The brachial plexus
A large number of neck swelling cases, however, are related to the enlargement of the lymph nodes, which can be caused by a large number of possible factors or conditions. Lymph nodes may swell when the body is fighting a mild viral or bacterial infection. However, enlarged lymph nodes also occur with cancer, thyroid problems, and autoimmune diseases.
If the swelling is made up of a soft tissue mass, it may be a sign of:
If the swelling is caused by fat pads, it may indicate:
- Cushings syndrome
Swelling of the glands may suggest:
- Multinodular goiter
- Graves disease
- Salivary duct stones
Neck lumps may also take the form of cysts, such as:
Thyroglossal duct remnants – Usually felt above the thyroid cartilage and may seem to disappear especially when swallowing and moves when the tongue is extended out
Sebaceous cysts – Local skin cysts that develop from clogged follicles
Dermoid cysts – Usually appears in the sternal notch area
Bacterial causes include:
- Strep throat
- Cat scratch disease
- Bacterial pharyngitis
- Abscess in the tonsils
Viral causes include:
- Human papillomavirus
- Rubella or German measles
- Viral pharyngitis
On the other hand, malignant masses and serious conditions that have been associated with neck lumps include:
- Cancer of the neck, head, lungs, skin, throat, thyroid gland, salivary gland, or breast
- Non-Hodgkin’s lymphoma
- Hodgkin’s disease
If there seems to be some abnormal swelling in the neck, it is possible to do a self-check by pressing the fingertips against the neck and moving it in a gentle rotating or sliding manner. However, it is still best to have the swelling professionally examined.
Among children, neck masses are usually caused by minor infections that are easily treatable; the lumps often go away once the infection has cleared. Among adults, the majority is caused by benign masses. Although there is a possibility that these masses are linked to cancer, the chances of this occurring is influenced by a person’s age, habits, and lifestyle. The risk of a lump being malignant is higher among individuals aged 40 and older as well as smokers and frequent drinkers.
To diagnose a neck lump, doctors will do a hands-on evaluation to determine its nature, which can be:
- Bilateral swelling of the neck
- Midline neck mass
- Lateral neck mass
- Neck edema
- Unilateral neck mass
Doctors examining a neck mass will also check for other symptoms. The combination of the following symptoms will help determine the real cause of the problem.
- Weight loss
- Rapid heartbeat
- Night sweating
- Prone to infection
- Ear infections or ear pain (especially persistent and recurrent ones)
- Hoarse voice (which may occur after the neck or the vocal cords suffer injury)
- Difficulty swallowing or some pressure on the esophagus
- Breathing problems or blocked airways
- Sore throat
- Mouth sores
- Tongue ulcers
- Bloody saliva
- Bloody mucus
- Any noticeable changes in the skin
Who to See and Types of Treatments Available
Any swelling in the neck should be checked out by either a general physician/family doctor or ENT specialists, who specialize in the diagnosis and treatment of conditions affecting the neck and the sinuses.
A test called otorhinolaryngoscopy is usually performed to diagnose the condition. This uses a lighted instrument to visually examine the ears, nose, and throat for signs and symptoms. Doctors may also require other tests to detect possible causes or rule out other diseases, such as the following:
- CBC or complete blood count to check for infections
- X-ray of the chest or sinuses
- Ultrasound of the neck
- MRI of the head and neck
- HIV screening
Neck lumps are not classified as medical conditions but symptoms of an underlying medical cause. For minor bacterial infections, the primary course of treatment is a round of antibiotics. For malignant masses, patients may choose to undergo:
Pfaff JA, Moore GP. Otolaryngology. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Elsevier Mosby; 2009:chap 70.
Chen A, Otto KJ. Differential diagnosis of neck masses. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Elsevier Mosby; 2010:chap 116.