I typically request plasma viscosity as part of investigating suspicious neck lumps, but it seems this actually isn’t useful. For persistent posterior node enlargement, an FBC and IM screen can be worthwhile, and obviously any lump in the thyroid should be investigated with TFTs, but other than that investigations aren’t helpful. Instead, look for red flags:
- Persistent sore throat
- Voice change
- Weight loss/anorexia
Also, be wary of:
- Hard or rubbery consistency
- >1 cm diam
- Changes in the oral cavity – lesions, leucoplakia/erythroplakia, limitation of tongue movement
- High risk background (smoker, heavy drinker)
- Fixed lump
- Rapid growth
And remember to assess axillary/groin nodes, chest, & liver/spleen.
The regions of the nodes are as follows:
- Submental – drains lip, mouth, skin of lower face.
- Upper jugular – oropharynx (tonsil & base of tongue) & parotid
- Mid-jugular – larynx, hypopharynx, & thyroid
- Supraclavicular – as for mid-jugular, plus lung, breast, & also GI & GU tract
- Posterior triangle – scalp & nasopharynx, may also be affected in lymphoma.
- Paratracheal – thyroid, larynx.
Lumps that are superficial to muscle/fascia are likely to be sebaceous cysts or lipomas, just as would be the case anywhere else. For deeper lumps, the categories for differential diagnosis are:
- Inflammatory: either infective or auto-immune. Auto-immune causes can include Sjogren’s syndrome, lupus, sarcoidosis.
- Congenital: eg branchial cyst, lymphangioma or haemangioma. Longstanding asymptomatic lumps.
- Neoplastic: benign or malignant
- Other: sialolithiasis, cervical rib in thin adult