Pynnonnen et al evaluated adults with a neck mass. They developed an algorithm for evaluating the patient. The authors are from multiple institutions in the United States.

Patient selection: adult with a neck mass


Decision points:

(1) evidence of a bacterial (or other) infection?

(2) one or more reasons to suspect malignancy?

(3) diagnosis obtained?

(4) resolution?


If there is evidence of a bacterial infection, then antibiotics are given. Ideally the pathogen should be identified and therapy given accordingly.


If there is reason to suspect malignancy, then:

(1) inform and educate the patient

(2) perform history and ENT physical exam

(3) perform contrast-enhanced CT or MRI of neck

(4) perform sampling for pathology (FNA, biopsy, other)

If a diagnosis is obtained then manage according to guidelines.

If the diagnosis is not obtained then continue workup with expanded exam. Do not assume that a cystic lesion is benign.


If the lesion is not infectious or suspicious for malignancy, then:

(1) perform history and physical exam

(2) perform ancillary tests as appropriate

(3) develop a plan for follow-up


If there is resolution of the mass then algorithm ends.

If the mass does not resolve then continue work-up until diagnosis made.

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