🦷 Neck Mass · Lymphadenitis · Branchial cleft · Thyroglossal duct · Lymphoma

Schwartz Clinical Handbook — Chapter 54 · Anterior triangle (thyroglossal, dermoid) · Posterior triangle (cystic hygroma) · Midline vs lateral · Hodgkin · Suppurative adenitis

Select location (midline vs anterior triangle vs posterior triangle), mobility with swallowing/tongue protrusion, tenderness, fluctuance, transillumination, systemic symptoms, and ultrasound findings → differentiate thyroglossal duct cyst, branchial cleft cyst, cystic hygroma, reactive/suppurative adenitis, lymphoma, or dermoid.
⚠️ Red flags: supraclavicular node, rapidly growing firm mass, systemic symptoms (fever, weight loss, night sweats) → excisional biopsy, chest X‑ray for mediastinal mass.

📋 Step 1 — Location, movement & characteristics
📌 Diagnostic impressions
📖 Schwartz Ch 54

Select midline vs lateral, movement with tongue protrusion (thyroglossal), transillumination (cystic hygroma), tenderness (adenitis), fluctuance (abscess), supraclavicular location, and systemic symptoms (fever, weight loss, night sweats) → differentiate congenital (thyroglossal, branchial, dermoid, cystic hygroma) from infectious (viral, bacterial, atypical mycobacteria) from malignant (lymphoma, metastatic).

✔️ Thyroglossal: midline, moves with swallowing/tongue protrusion.
✔️ Branchial: anterior triangle, lateral, anterior to SCM.
✔️ Cystic hygroma: posterior triangle, soft, transilluminates.
✔️ Suppurative adenitis: tender, fluctuant, fever.
✔️ Lymphoma: rubbery, matted, supraclavicular, B symptoms.
📘 Schwartz pearls (Chapter 54)
• Thyroglossal duct cyst: most common congenital neck mass; Sistrunk procedure.
• Branchial cleft cyst: second most common; infected cyst mimics adenitis.
• Cystic hygroma: lymphangioma, may enlarge with URI; sclerotherapy or excision.
• Supraclavicular node: always pathologic → biopsy.
• Suppurative adenitis: ultrasound, incision/drainage if fluctuant, antibiotics.