Evaluating Neck Masses in Adult and Pediatric Patients

Gordon H. Sun, MD, MS


April 16, 2019

Slow-Growing Neck Mass in an Adult

A 48-year-old male manager of a consulting firm presented to his primary care provider for his annual physical examination. During the history, he noted that he had a nonpainful, slow-growing lump on the left side of his neck that he first noticed a couple of months ago while shaving. He said he was not particularly bothered by it because it didn't hurt and was not growing quickly. Upon further questioning, he noted that he had had an intermittent sore throat and odynophagia, which he believed was due to a lingering cold. He also reported weight loss of 10 lb over the past 4 months, telling you that he had not been trying to lose weight but "wasn't complaining about it."

The patient denied fevers, malaise, dyspnea, or voice changes. His medical history was significant for hypertension and type 2 diabetes mellitus, both of which were controlled with medications. He denied any illegal recreational drug use, but admitted to smoking one-half pack of cigarettes daily for the past 30 years and drinking an average of four to six beers on the weekend. He further reported ongoing sexual activity with multiple partners without condoms. The patient had no known drug, food, or environmental allergies.

The physical examination demonstrated a well-nourished, well-appearing man whose vital signs were within normal limits. The head and neck examination revealed an asymmetrically enlarged left tonsil with reddish ulceration, as well as a firm, fixed mass in the left lateral neck measuring 2 x 2 cm, with no overlying skin changes. No cranial nerve deficits were observed, and no audible stridor or dysphonia was appreciated. The remainder of the physical exam was unremarkable.


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