Midline Neck Swellings: Clinical Approach

A neck swelling includes any mass that presents in the neck whatever its origin is. Swellings of the neck are generally categorized into two groups: midline and lateral neck swellings. Both may be further classified as congenital versus acquired, solid versus cystic, benign versus malignant, or according to the anatomical subregion of presentation. While infections cause most of the neck masses in children, most persistent neck masses in adults are neoplasms and evidence suggest that a neck mass in the adult patient should be considered malignant until proven otherwise. This chapter provides the clinician with a systematic approach to a patient with any midline neck swelling, and a guide to appropriate investigations so that the proper diagnosis could be made. The proposed clinical approach involves an understanding of the anatomy of the lymph nodes and major structures of the neck and the possible pathology that may arise in such structures. If one can first identify the structure that is enlarged causing the mass and second match that with the pathologies that may occur within that structure, then most of the challenge is solved, and appropriate investigations and adequate treatment can be performed.