A practical guide to differentiating lumps in the neck
- By: Benjamin Davies, Mark Felton, Andrew Camilleri
Neck swellings are a common clinical occurrence and often feature in medical student examinations. The neck contains many different structures, which can give rise to swellings, both benign and serious. Accurate differentiation requires a thorough history taking and examination. This article aims to help students understand the anatomy of the neck and to differentiate the common causes of neck swelling.
While taking a history, you should ask about the swelling, associated symptoms, and medical, family, and social history (box 1).345 Although many characteristics of the swelling will be discovered during an examination, this only represents a clinical snapshot. Questions about the onset and development of swellings, including any tenderness or variation in size, are informative in the differential diagnosis. A patient’s concerns and expectations should be explored, which may aid subsequent explanation of possible differential diagnoses and therefore further investigations.
Box 1 lists the important associated symptoms to consider. Among