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

Take a test on this article and claim your certificate on MIMS Learning

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

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

GP training: Useful resources when preparing for the AKT

GP training: Useful resources when preparing for the AKT

Dr Branavan Anandasundaram highlights useful resources that GP trainees can use to...

GP training: How to succeed in the AKT

GP training: How to succeed in the AKT

Dr Branavan Anandasundaram passed the AKT earlier this year with a score of 89.5%....

Medico-legal: Advice on prescribing opioids

Medico-legal: Advice on prescribing opioids

The MDU's Dr Ellie Mein advises on how to avoid the medico-legal risks associated...

Map: How CQC ratings for general practice vary across England

Map: How CQC ratings for general practice vary across England

An overwhelming 95% of GP practices in England are rated either 'good' or 'outstanding'...

Rise in GP waiting times 'driving more patients to Google health advice'

Rise in GP waiting times 'driving more patients to Google health advice'

Longer waits for GP appointments may be pushing more patients to search for health...

GP locum rates continue to rise in most parts of the UK, poll reveals

GP locum rates continue to rise in most parts of the UK, poll reveals

Average hourly rates received by locums have risen across England over the past 12...