Neck swellings: differential diagnoses

The differences in characteristic features of neck swellings - thyroglossal cyst, cervical lymphadenopathy, goitre and abscess.

Thyroglossal cyst

Presentation

  • Most common congenital abnormality of the neck
  • Occurs in up to 7% of population, most commonly in first decade of life
  • Fluctuant midline swelling moves up when patient protrudes tongue
  • Usually non-tender and mobile, unless infected

Management

  • Diagnosis made on history and examination
  • If thyroid cannot be palpated, ultrasound or CT advisable
  • Malignant transformation very rare, but can occur
  • Surgical excision will confirm diagnosis, prevent infection, improve cosmetic appearance and avoid malignant change

Cervical lymphadenopathy

Presentation

  • Varied aetiology
  • Most common cause is a viral URTI
  • Chronic swelling requires investigation to exclude serious aetiology
  • FBC and CRP can be helpful
  • If diagnosis in doubt, excision biopsy may be required

Management

  • Treatment should be focused on the underlying cause

Goitre

Presentation

  • Enlargement of thyroid gland
  • Varied aetiology
  • May be associated with underactive or overactive thyroid
  • Can be asymptomatic
  • In extreme cases, may affect swallowing or breathing
  • Ultrasound and biopsy can aid diagnosis

Management

  • Treatment depends on cause, size and symptoms
  • If euthyroid, asymptomatic and benign, treatment not usually required
  • Treatment options include surgical excision or radioactive iodine therapy

Abscess

Presentation

  • Acute onset with pain, redness and swelling
  • May be associated with systemic symptoms, such as fever and vomiting
  • If located around the jaw, underlying problem may be dental infection

Management

  • Treatment should focus on underlying infection, with oral or IV antibiotics
  • Paracetamol can be helpful for pain or pyrexia
  • Incision and drainage may be required
  • In dental infection, tooth extraction may be required

Dr Stollery is a GP in Leicestershire

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This is an updated version of an article that was first published in April 2014.

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