A person who presents with a neck mass can be evaluated using the "rule of 7."

Cause of a Neck Mass


typical duration of an inflammatory neck mass

7 days

typical duration of a neoplastic neck mass

7 months

typical duration of a congenital mass

7 years

percentage of congenital masses that are thryoglossal duct cysts



Factors that may impact the interpretation:

(1) age of the patient

(2) presence of risk factors for head and neck cancer (see Chapter 27)

(3) presence of focus of infection in the head or neck (dental, pharynx, other)

(4) concurrent local (erythema, edema, etc.) or system signs (fever, sepsis) of infection

(5) presence of a draining sinus or fistula

(6) presence at birth

(7) country (for example, tuberculous lymphadenitis might be considered in a developing country but would be unusual in a developed country)

(8) consistency (hard in cancer, firm with fibrosis, cystic)

(9) number of masses identified

(10) past or current history of malignancy


Often a patient will be monitored for a few weeks to see if the mass goes away. Sometimes a course of antibiotics may be tried. If the mass persists or enlarges then either aspiration or biopsy of the mass may be performed.


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