Dd for swelling in front OF neck

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"neck mass" AND differential diagnosis

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adult neck mass evaluation differential diagnosis thyroid midline neck mass guideline

Differential diagnosis of swelling in the front of the neck

Think first by site: midline versus off-midline, and whether it moves on swallowing or tongue protrusion.

Likely cause	Typical clues
Thyroid enlargement (goiter)	Diffuse or nodular lower anterior-neck swelling; usually moves on swallowing. May be euthyroid or have hyper/hypothyroid symptoms.
Thyroid nodule / thyroid cyst	Focal lump in the thyroid region, moving with swallowing. Most are benign, but hard, fixed, rapidly enlarging, or associated with neck nodes requires evaluation.
Thyroglossal duct cyst	Common congenital midline, usually painless lump near the hyoid bone; characteristically moves with swallowing and protrusion of the tongue. Can become infected.
Dermoid or epidermoid cyst	Slow-growing, painless, doughy midline lump, often in the submental or upper anterior neck. Usually does not move with tongue protrusion.
Reactive/infective lymphadenitis	Tender enlarged nodes, often with sore throat, dental infection, skin/scalp infection, fever, or recent upper-respiratory infection. Anterior cervical nodes may be involved.
Acute suppurative lymph node/neck abscess	Painful, red, warm, fluctuant swelling with fever and toxicity. Requires urgent assessment.
Laryngocele	Soft swelling in the upper anterior/lateral neck that may enlarge with coughing, straining, or blowing.
Congenital cysts other than thyroglossal cyst	Branchial cysts are usually lateral, but may be perceived as anterior depending on size/location.
Lipoma	Soft, mobile, painless, slowly enlarging subcutaneous mass; does not move with swallowing.
Salivary-gland pathology	Usually submandibular rather than central; may worsen around meals if due to a stone.
Neoplasm	Thyroid cancer, lymphoma, metastatic head-and-neck squamous-cell carcinoma, or less commonly soft-tissue tumors. In an adult, a persistent unexplained neck mass should be assessed for malignancy.

Useful examination distinctions

Moves with swallowing: thyroid swelling, thyroglossal duct cyst.
Moves with tongue protrusion: thyroglossal duct cyst.
Tender, warm, acute onset: infection/inflammation.
Soft and freely mobile in skin/subcutaneous tissue: lipoma or epidermoid cyst.
Hard, fixed, irregular, persistent: suspect malignancy and investigate.

Red flags needing urgent ENT/medical assessment

Breathing difficulty, noisy breathing, dysphagia, drooling, or rapidly progressive swelling
Fever with severe pain, redness, or systemic illness
Hard/fixed mass, ulceration, vocal hoarseness, unexplained weight loss, night sweats
A neck lump persisting for more than 2-3 weeks in an adult, particularly with smoking, alcohol exposure, or HPV-related head-and-neck cancer risk

Initial work-up commonly includes focused head-and-neck examination, thyroid function tests if thyroid disease is suspected, neck/thyroid ultrasound, and fine-needle aspiration when indicated. The AAO-HNS adult neck-mass guideline emphasizes prompt evaluation of persistent adult neck masses because malignancy must be excluded.

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