Neck Swelling

First actions / assessment

• Assess ABCDE first and decide immediately whether there is airway risk. Clarify onset, duration, progression, pain, fever, recent URTI or dental infection, sore throat, odynophagia, dysphagia, drooling, trismus, voice change, weight loss, night sweats, TB exposure, cat exposure, skin lesions, salivary swelling with meals, thyroid symptoms, recent trauma or line placement, anticoagulant use, smoking and alcohol history, prior head and neck cancer, radiation exposure, and immunosuppression. On examination note site (midline vs lateral
• anterior vs posterior triangle), size, tenderness, warmth, erythema, fluctuance, consistency, mobility/fixation, pulsatility, transillumination if relevant, skin tethering, oral cavity and dentition, floor of mouth, tonsils/pharynx, salivary glands, thyroid enlargement or nodules, cranial nerves, and other lymph node groups. In children and young adults think congenital/infective causes more often
• in adults, especially >40, a persistent lateral neck mass is malignant until proven otherwise. Digital oral/pharyngeal examination and nasoendoscopy may be needed by ENT. Investigations depend on presentation: bedside glucose and vitals if unwell