Differential diagnosis of neck lumps

The anatomical position of the lump should help narrow down the possible differential diagnoses. The table below summarises the main differential diagnoses of a neck lump.

Superficial Structures	Midline structures	Lateral Structures
		Anterior triangle	Posterior triangle
Sebaceous cyst	Thyroglossal cysts	Thyroid lobe swellings	Lymphadenopathy
Lipoma	Thyroid swelling	Pharyngeal Pouch	Carotid artery aneurysm
Abscess	Laryngeal swelling	Branchial cyst	Carotid body tumour
Dermoid cyst	Submental lymph nodes	Submandibular lymph gland pathology	Cystic Hygroma
	Dermoid cyst	Lymphadenopathy	Cervical rib
	Chondroma of thyroid cartilage	Parotid gland swelling	Torticollis
		Laryngocoele

A quick and easy way of thinking about differential diagnoses is grouping them according to the age of the patient that you are examining.

You may like to print off this quick guide to add to your notes.

Printable: differential diagnosis relating to age

Extended knowledge

A common differential diagnosis of a neck lump is lymphadenopathy.

Causes of lymphadenopathy include:

Infective:

Viral - (e.g. infectious mononucleosis, HIV)

Bacterial - (e.g. any bacterial infection of the head/neck, tuberculosis)

Malignant:

Primary - (e.g. lymphoma)

Secondary - (e.g. metastatic cancer)

Learning Bite

Firm, rubbery non-tender lymph nodes are usually associated with lymphoma.

Tumours from the head and neck usually metastasise to nodes in the submandibular region and the upper part of the anterior triangle.

Tumours of the chest and abdomen usually metastasise to the lower part of the posterior triangle.

Finding a hard non-tender left supraclavicular node (Virchow’s node) is known as Troisier's sign and often indicates abdominal malignancy.

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