A 45-Year-Old Man With Gradual Neck Swelling

Jitendra Gohil, MD; Pramod Gupta, MD


November 30, 2016

Physical Examination and Workup

On physical examination, the patient is afebrile and has a pulse of 72 beats/min, a blood pressure of 130/82 mm Hg, a respiratory rate of 12 breaths/min, and a normal oxygen saturation while breathing room air. He is well-developed and well-appearing.

Examination of the anterior neck reveals a nontender, nonerythematous, fluctuant mass measuring approximately 10 × 8 cm in the midline of the lower neck, with slight extension to the right side of the midline. The mass moves up and down when the patient swallows, and it slightly displaces anteriorly with protrusion of the tongue.

Figure 1.

Figure 2.

No cervical lymphadenopathy is appreciated. The lung fields are clear bilaterally, without evidence of stridor or wheeze. The heart has a regular rate and rhythm, without murmurs, and the abdomen is soft and nontender, without evidence of masses. The cranial nerves are intact, and the remainder of the neurologic exam is unrevealing.

Routine laboratory blood tests, including a complete blood cell count and an electrolyte panel, and a rapid assay for thyroid function are obtained. All laboratory investigations, including the thyroid studies, are within normal limits.

Ultrasound of the neck is obtained (Figure 1). CT of the neck is also performed for further evaluation (Figure 2).


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