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Updated 11 February 2013

Neck lump

A neck lump is any bump, bulge or puffiness in the neck.

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Definition

A neck lump is any bump, bulge or puffiness in the neck.

Causes


  • Atypical Mycobacterium

  • Atypical mycobacterium is a bacterium that affects HIV patients with a CD4 count of less than 50.  It causes swelling/enlargement of the lymph nodes in the neck.  The lymph nodes/lumps will not be painful and are usually connected and will form a large mass in the neck.  Other symptoms will include malaise, anorexia, abdominal pain, nausea and vomiting.
    You should consult your doctor immediately if you have these symptoms, in order to have a fine needle aspiration done, as well as an ultrasound and CT scan of these nodes.
  • Cat scratch disease
    Three to five days after you have been scratched by a cat, red bumps will appear.  It will develop into non-itching papules and after three days it will turn into crust that will heal with a scar.  Solitary lymphadenopathy (enlargement of lymph nodes) can be present in the affected area (the neck), three to four weeks after you have been scratched.  These nodes can be painful but will resolve spontaneously after two to four months.  A low grade fever, as well malaise and joint pain may be present.
    This can be treated at home with anti-inflammatories.  Contact your doctor if your symptoms worsen, in order to have a CSD skin test and to have possible antibiotics prescribed.

  • Pharyngitis
    Pharyngitis is inflammation of the pharynx and/or tonsils.  It is usually caused by a viral infection and is self- limited.  In severe cases it can cause lymph node enlargement on both sides of the neck and it will be tender to the touch.  You can experience systemic symptoms such as tiredness and a high fever.  Non-infectious causes can include dry air, post-nasal drip, reflux gastritis, smoking, cancer, chemical injury and trauma to the throat.
    You can treat this condition at home by taking non-steroidal anti-inflammatories and taking Strepsils every four hours.  When you think you have pharyngitis, it is best to consult your doctor to have the correct diagnosis made.

  • Peritonsillar abscess
    This is an extension of tonsillar infection beyond the capsule with abscess formation usually above and behind the tonsil.  It will cause swelling (a lump) in the neck on the side of the tonsillar abscess and will be tender.  You will also experience systemic symptoms such as tiredness, malaise and fever.
    You have to consult your doctor immediately, in order to have the abscess drained under local anaesthetic and to start with a course of oral antibiotics, as well taking pain killers.

  • Tuberculosis
    Tuberculosis is a disease that usually affects the lungs.  Systemic tuberculosis can affect any part of the body.  If it is present in the nodes of the neck, it can cause a very large lump with an irregular margin.  It will not be tender.  Symptoms such as  malaise, fever and tiredness will be experienced.
    Contact your doctor immediately if you experience the above symptoms, in order to start with the correct treatment.

  • Strep throat
    See pharyngitis.

  • Tonsillitis
    This is infection of one or both tonsils.  It will cause swelling (a lump) in the neck just below the jaw line.  You can treat tonsillitis at home with anti-inflammatories.  Consult your doctor to have an examination done and to start with a course of antibiotics.

  • Herpes Zoster (shingles)
    Shingles is a latent reaction of chicken pox.  This virus lies dormant in the dorsal ganglia until it is reactivated by stress, trauma, medication and other possible systemic infections.  The rash is confined to a specific dermatoma on the face/neck.  It can therefore, appear anywhere on the face/neck.  This condition is extremely painful and causes systemic effects, such as. malaise, fever and general sweating.  Shingles can also cause enlarged lymph nodes in the neck, which will present as a lump.
    You should consult your doctor for treatment.  He will prescribe tricyclic, as well as anti-viral therapy that includes topical anti-viral cream and acyclovir orally.

  • HIV disease

  • Infectious mononucleosis
    This is a clinical syndrome typically characterised by fever, pharyngitis, lymphadenopathy (enlarged lymph nodes in the neck) and atypical lymphocytosis (general infection of the lymph nodes).  It is most commonly caused by the Epstein - Barr virus.  It is usually diagnosed in patients younger than 35 and who have just experienced symptoms of malaise, fatigue, low grade fever and painful joints for three to seven days.
    You should consult your doctor immediately, in order to have a mono-spot test done.  In less severe cases, it will be treated with analgesics and bed rest.

  • Rubella (German measles)
    German measles is an infection caused by the Rubella virus.  It is transmitted through aerosolised droplets of infected patients.  German measles will cause lymphadenopathy (enlarged, swollen, tender, well defined lymph nodes/lumps) in the neck. Other symptoms may include eye pain, generalised body pain, chills, anorexia, sore throat and pruritic rash (red spots).
    You can treat German measles at home with oatmeal baths and bed rest, as well as taking oral anti-inflammatories for the body pain.  You should consult your doctor if you are unsure about the diagnosis.

  • Leukaemia
    Leukaemia is a disease of the white blood cells in the body.  It may appear as a lump in the neck when the disease has spread to the lymphatic system.  Other symptoms are malaise and anorexia.  Consult your physician regarding treatment.

  • Metastatic oral lesions (mouth cancer)
    Mouth cancer will present as a lump in the neck when it has spread to the localised lymph nodes. A lump can also be caused by a mass caused by the mouth cancer itself.  You should consult your doctor immediately.

  • Hodgkin’s & Non-Hodgkin’s lymphoma
    These conditions are tumours of the immune system.  The diagnosis varies from Hodgkin’s and Non-Hodgkin’s disease.  There are different stages of the disease.  Stage one:  painless localised single lymph node in the cervical or neck area and may appear as a single lump.  Stage two:  more than one lymph node or group but will be confined to one side of the diaphragm.  Stage three:  disease of lymph nodes or spleen occurring on both sides of diaphragm.  Stage 4: involves the liver and bone marrow.  Symptoms are a high grade fever, as well as night sweat, malaise and weight loss.
    You should consult your doctor regarding treatment immediately.

  • Thyroid cancer
    Thyroid cancer is abnormal thyroid tissue with uncontrolled cellular proliferation and a tendency to invade locally or metastasise to the lymph nodes.  Proliferation to the lymph nodes will cause a lump on either side of the neck that will be central and feel hard and non-tender.
    You should consult your doctor immediately if you suspect thyroid cancer, in order to have the necessary blood tests done, as well as a scan.

  • Goiter
    Goitre is an enlargement of the thyroid gland.  It is commonly visible as swelling (a lump) of the front of the neck.  It is often a result from insufficient iodine intake and is usually accompanied by hypothyroidism (under active thyroid).
    You can treat this condition by supplementing your iodine intake.

  • Food and drug allergies
    This will cause itchy, red, inflamed lumps/hives in the neck and the rest of the body.  Drug allergies are normally caused by drugs such as penicillin and aspirin.
    These can be treated at home with anti-histamines and a topical cream such as Antisana.  If symptoms are accompanied by shortness of breath, you should contact your doctor immediately.

  • Mumps

  • The incubation period of mumps is 14 – 24 days; symptoms experienced before the onset of the disease include fever, general body pain (especially neck) and malaise. The classic presentation is pain and swelling in one or both parotid glands and you will have a moderate fever. Mumps peak in the first three days and will subside within three to seven days.  The submandibular glands are often also involved and it will appear as big lumps just below the jaw line.  Occasionally you will have a rash on your trunk.
    Treatment at home will be bed rest and adjusting your diet if you have problems with chewing.  If you experience severe body pain/joint pain, you should consult your doctor. He/she will probably prescribe a two- week course of corticosteroids.  If you have inflammation of the testis in conjunction with the mumps, you should wear tight underwear and get enough bed rest (as much as possible).
  • Salivary gland tumour
    Salivary glands produce saliva which is the fluid present in the mouth and throat.  There are three types of salivary glands, i.e. parotid glands, submandibular glands, sublingual glands. Most tumours of the salivary glands begin in the parotid glands and only 10% to 15% start in the submandibular glands.  The rest develop in the sublingual salivary glands.  Tumours of the parotid and submandibular glands are usually non-cancerous.  Tumours in the minor salivary glands (smallest glands) are usually cancerous.
    Consult your physician immediately if you suspect that you have a tumour.  These tumours are well treated with surgery.

  • Stone in salivary duct
    Stones can form in the duct of the salivary gland.  This will block the normal flow of saliva and cause swelling of the salivary glands. It is a benign lump. It will be soft and tender.  The stone usually gets flushed out as the pressure increase in the salivary glands and the lump/swelling will resolve spontaneously.
    If the stone does not get flushed out, you should consult your physician to have the stone surgically removed.

Written by Dr Anrich Burger, MB ChB (Stell)

 
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